351
|
Seo C, Kim S, Lee M, Cha MU, Kim H, Park S, Yun HR, Jhee JH, Kee YK, Han SH, Yoo TH, Kang SW, Park JT. THYROID HORMONE REPLACEMENT REDUCES THE RISK OF CARDIOVASCULAR DISEASES IN DIABETIC NEPHROPATHY PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM. Endocr Pract 2018; 24:265-272. [PMID: 29547051 DOI: 10.4158/ep-2017-0017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Patients with diabetic nephropathy (DMN) have an increased risk of cardiovascular disease (CVD). However, strategies to reduce this risk are limited. Thyroid hormone replacement therapy (THRT) in patients with hypothyroidism has been shown to reduce several surrogate markers of CVD. Therefore, we performed a study to determine if THRT would reduce CVD risk in patients with subclinical hypothyroidism (SCH) and DMN. METHODS This was a retrospective, nonrandomized study of patients with type 2 diabetes, DMN, and SCH. Those with known thyroid dysfunction or taking THRT at baseline were excluded. Patients receiving THRT for at least 180 days were included in the THRT group, while the remaining patients were assigned to the non-THRT group. The primary outcome was CVD events, which included coronary syndrome, cerebrovascular events, and peripheral artery diseases. RESULTS Among the 257 patients, 83 (32.3%) were in the THRT group. The mean ages were 62.7 ± 12.3 and 66.8 ± 12.4 years in the THRT and non-THRT groups, respectively. The corresponding numbers of male patients were 32 (40.0%) and 94 (53.1%). During a mean follow-up of 38.0 ± 29.2 months, 98 CVD events were observed. Acute coronary syndrome and cerebrovascular event prevalence rates were lower in the THRT group than the non-THRT group, but there was no difference for peripheral artery diseases. Multivariate Cox analysis revealed that THRT was independently associated with a decreased CVD event risk. CONCLUSION THRT may decrease the risk of CVD in DMN patients with SCH. Randomized trials are needed to verify this finding. ABBREVIATIONS CV = cardiovascular DMN = diabetic nephropathy eGFR = estimated glomerular filtration rate fT4 = free thyroxine HbA1c = glycosylated hemoglobin HR = hazard ratio hs-CRP = high-sensitivity C-reactive protein LDL-C = low-density lipoprotein cholesterol SCH = subclinical hypothyroidism T2DM = type 2 diabetes THRT = thyroid hormone replacement therapy TSH = thyroid-stimulating hormone.
Collapse
|
352
|
Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol 2018; 2:13. [PMID: 30202791 PMCID: PMC5988734 DOI: 10.1038/s41698-018-0056-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
Angiogenesis inhibitors targeting the vascular endothelial growth factor (VEGF) signaling pathway (VSP) have been important additions in the therapy of various cancers, especially renal cell carcinoma and colorectal cancer. Bevazicumab, the first VSP to receive FDA approval in 2004 targeting all circulating isoforms of VEGF-A, has become one of the best-selling drugs of all times. The second wave of tyrosine kinase inhibitors (TKIs), which target the intracellular site of VEGF receptor kinases, began with the approval of sorafenib in 2005 and sunitinib in 2006. Heart failure was subsequently noted, in 2-4% of patients on bevacizumab and in 3-8% of patients on VSP-TKIs. The very fact that the single-targeted monoclonal antibody bevacizumab can induce cardiotoxicity supports a pathomechanistic role for the VSP and the postulate of the "vascular" nature of VSP inhibitor cardiotoxicity. In this review we will outline this scenario in greater detail, reflecting on hypertension and coronary artery disease as risk factors for VSP inhibitor cardiotoxicity, but also similarities with peripartum and diabetic cardiomyopathy. This leads to the concept that any preexisting or coexisting condition that reduces the vascular reserve or utilizes the vascular reserve for compensatory purposes may pose a risk factor for cardiotoxicity with VSP inhibitors. These conditions need to be carefully considered in cancer patients who are to undergo VSP inhibitor therapy. Such vigilance is not to exclude patients from such prognostically extremely important therapy but to understand the continuum and to recognize and react to any cardiotoxicity dynamics early on for superior overall outcomes.
Collapse
Affiliation(s)
- Rhian M. Touyz
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| |
Collapse
|
353
|
Liu X, Du H, Chai Q, Jia Q, Liu L, Zhao M, Li J, Tang H, Chen W, Zhao L, Fang L, Gao L, Zhao J. Blocking mitochondrial cyclophilin D ameliorates TSH-impaired defensive barrier of artery. Redox Biol 2018; 15:418-434. [PMID: 29353219 PMCID: PMC5975066 DOI: 10.1016/j.redox.2018.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS Endothelial cells (ECs) constitute the defensive barrier of vasculature, which maintains the vascular homeostasis. Mitochondrial oxidative stress (mitoOS) in ECs significantly affects the initiation and progression of vascular diseases. The higher serum thyroid stimulating hormone (TSH) level is being recognized as a nonconventional risk factor responsible for the increased risk of cardiovascular diseases in subclinical hypothyroidism (SCH). However, effects and underlying mechanisms of elevated TSH on ECs are still ambiguous. We sought to investigate whether cyclophilin D (CypD), emerging as a crucial mediator in mitoOS, regulates effects of TSH on ECs. METHODS AND RESULTS SCH patients with TSH > = 10mIU/L showed a positive correlation between serum TSH and endothelin-1 levels. When TSH levels declined to normal in these subjects after levothyroxine therapy, serum endothelin-1 levels were significantly reduced. Supplemented with exogenous thyroxine to keep normal thyroid hormones, thyroid-specific TSH receptor (TSHR)-knockout mice with injection of exogenous TSH exhibited elevated serum TSH levels, significant endothelial oxidative injuries and disturbed endothelium-dependent vasodilation. However, Tshr-/- mice resisted to TSH-impaired vasotonia. We further confirmed that elevated TSH triggered excessive mitochondrial permeability transition pore (mPTP) opening and mitochondrial oxidative damages in mouse aorta, as well as in cultured ECs. Genetic or pharmacological inhibition of CypD (the key regulator for mPTP opening) attenuated TSH-induced mitochondrial oxidative damages and further rescued endothelial functions. Finally, we confirmed that elevated TSH could activate CypD by enhancing CypD acetylation via inhibiting adenosine monophosphate-activated protein kinase/sirtuin-3 signaling pathway in ECs. CONCLUSIONS These findings reveal that elevated TSH triggers mitochondrial perturbations in ECs and provide insights that blocking mitochondrial CypD enhances the defensive ability of ECs under TSH exposure.
Collapse
Affiliation(s)
- Xiaojing Liu
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Heng Du
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, TX 75080, United States
| | - Qiang Chai
- Department of Cardiovascular Disease, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250001, China
| | - Qing Jia
- Department of Cardiovascular Disease, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250001, China
| | - Lu Liu
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Meng Zhao
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Jun Li
- Department of Pharmacy, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Hui Tang
- Department of Pharmacy, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Wenbin Chen
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Lifang Zhao
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Li Fang
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Ling Gao
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China; Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.
| | - Jiajun Zhao
- Deparment of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China; Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong 250021, China; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China.
| |
Collapse
|
354
|
Schneider C, Feller M, Bauer DC, Collet TH, da Costa BR, Auer R, Peeters RP, Brown SJ, Bremner AP, O’Leary PC, Feddema P, Leedman PJ, Aujesky D, Walsh JP, Rodondi N. Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary? PLoS One 2018; 13:e0196631. [PMID: 29709030 PMCID: PMC5927436 DOI: 10.1371/journal.pone.0196631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/15/2018] [Indexed: 01/07/2023] Open
Abstract
Objective Guidelines for thyroid function evaluation recommend testing TSH first, then assessing fT4 only if TSH is out of the reference range (two-step), but many clinicians initially request both TSH and fT4 (one-step). Given limitations of previous studies, we aimed to compare the two-step with the one-step approach in an unselected community-dwelling study population, and develop a prediction score based on clinical parameters that could identify at-risk patients for thyroid dysfunction. Design Cross-sectional analysis of the population-based Busselton Health Study. Methods We compared the two-step with the one-step approach, focusing on cases that would be missed by the two-step approach, i.e. those with normal TSH, but out-of-range fT4. We used likelihood ratio tests to identify demographic and clinical parameters associated with thyroid dysfunction and developed a clinical prediction score by using a beta-coefficient based scoring method. Results Following the two-step approach, 93.0% of all 4471 participants had normal TSH and would not need further testing. The two-step approach would have missed 3.8% of all participants (169 of 4471) with a normal TSH, but a fT4 outside the reference range. In 85% (144 of 169) of these cases, fT4 fell within 2 pmol/l of fT4 reference range limits, consistent with healthy outliers. The clinical prediction score that performed best excluded only 22.5% of participants from TSH testing. Conclusion The two-step approach may avoid measuring fT4 in as many as 93% of individuals with a very small risk of missing thyroid dysfunction. Our findings do not support the simultaneous initial measurement of both TSH and fT4.
Collapse
Affiliation(s)
- Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bruno R. da Costa
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Suzanne J. Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Alexandra P. Bremner
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Peter C. O’Leary
- School of Women's and Infants' Health, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Peter J. Leedman
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- UWA Centre for Medical Research, Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John P. Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|
355
|
Association between Low Free Triiodothyronine Levels and Poor Prognosis in Patients with Acute ST-Elevation Myocardial Infarction. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9803851. [PMID: 29850596 PMCID: PMC5926512 DOI: 10.1155/2018/9803851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 12/30/2022]
Abstract
Background Low free triiodothyronine (fT3) levels are generally associated with poor prognosis in patients with heart diseases, but this is controversial and there is a lack of data about ST-elevation myocardial infarction (STEMI) in Chinese patients. Objective To assess the association between fT3 levels and the prognosis of patients with STEMI. Methods This was a prospective observational study of 699 consecutive patients with STEMI treated at the Xinqiao Hospital between January 1, 2013, and December 31, 2014. The patients were divided into the low fT3 (fT3 < 3.1 pmol/L; n = 179, 27.5%) and normal fT3 (fT3 ≥ 3.1 pmol/L; n = 473, 72.5%) groups according to fT3 levels at admission. Patients were followed up at 1, 3, 6, and 12 months for all-cause death and major adverse cardiac events (MACE). Results During the 1-year follow-up, there were 70 all-cause deaths (39.1%) in the low fT3 group and 40 (8.5%) in the normal fT3 group (P < 0.001). MACE occurred in 105 patients (58.7%) in the low fT3 group and 74 (15.6%) in the normal fT3 group (P < 0.001). Multivariate Cox proportional hazards regression analysis indicated that fT3 levels were independently associated with 30-day and 1-year all-cause death [30-day: hazard ratio (HR) = 0.702, 95% confidence interval (95% CI): 0.501–0.983, P = 0.04; 1-year: HR = 0.557, 95% CI: 0.411–0.755, P < 0.001] and MACE (30-day: HR = 0.719, 95% CI: 0.528–0.979, P = 0.036; 1-year: HR = 0.557, 95% CI: 0.445–0.698, P < 0.001). Conclusion Low fT3 levels were strongly associated with poor prognosis in patients with STEMI. Measurement of fT3 levels may be a valuable and simple way to identify high-risk STEMI patients.
Collapse
|
356
|
Valamparampil MJ, Mohan A, Jose C, Sadheesan DK, Aby JJ, Vasudevakaimal P, Varghese S, Surendrannair AT, Ashokan AL, Madhusoodhanan RS, Ilyas IS, Rajeevan A, Karthikeyan SB, Devadhas KS, Raghunath R, Surendran S, Muraleedharanpillai H, Nujum ZT. Role of Geographic Information System in Assessing Determinants of Cardiovascular Disease: An Experience From a Low- and Middle-Income Country. Asia Pac J Public Health 2018; 30:351-360. [PMID: 29649883 DOI: 10.1177/1010539518768333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. The determinants of CVD in an urban population using conventional and geographic information system techniques were attempted as a community-based census-type cross-sectional study in Kerala, India, among 1649 individuals residing in 452 households. Sociodemographic details, risk factor exposures, and self-reported disease prevalence were determined. Location of houses, wells from which subjects drew drinking water, and distances of the house from the outer road (proxy for air pollution) were mapped using differential global positioning system and pH of water samples determined. Prevalence of CVD was 5.8%. Significant predictors of CVD were male gender, diabetes mellitus, hypertension, and hypothyroidism. Statistically significant spatial association was found between CVD and groundwater pH. Geographic information system technology is useful in identification of spatial clustering and disease hotspots for designing preventive strategies targeting CVD.
Collapse
Affiliation(s)
| | - Ananth Mohan
- 1 Government Medical College Hospital, Thiruvananthapuram, Kerala, India
| | - Chinu Jose
- 2 University of Kerala, Thiruvananthapuram, Kerala, India
| | | | - Jemin Jose Aby
- 1 Government Medical College Hospital, Thiruvananthapuram, Kerala, India
| | | | - Sara Varghese
- 3 Government Medical College Hospital, Kollam, Kerala, India
| | | | | | | | | | - Amjith Rajeevan
- 5 Directorate of Health Services, Government of Kerala, Pathanamthitta, Kerala, India
| | | | | | | | | | | | | |
Collapse
|
357
|
Su W, Zhao XQ, Wang M, Chen H, Li HW. Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction. J Cardiol 2018; 72:215-219. [PMID: 29580665 DOI: 10.1016/j.jjcc.2018.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low triiodothyronine (T3) syndrome (LT3S) is frequently seen in patients with acute myocardial infarction (AMI). We examined the association between LT3S and severity of myocardial injury and determined whether LT3S adds predictive value over thrombolysis in myocardial infarction (TIMI) risk score for in-hospital cardiovascular (CV) death. METHODS Of 2459 AMI patients, 529 pairs of euthyroid and LT3S individuals with similar baseline characteristics were identified using 1:1 propensity score matching. LT3S was defined as free T3 (fT3) <2.36pg/mL, normal values of thyroid-stimulating hormone and free thyroxin. Primary outcome was in-hospital CV death. Receiver operating characteristic curves were generated to assess the predictive effects of fT3, TIMI risk score, and TIMI-LT3S risk score on in-hospital CV death. RESULTS LT3S was found in 23.3% of patients with AMI. The peak values of cardiac troponin I in ng/mL and N-terminal pro-brain natriuretic peptide in ng/mL were significantly higher in LT3S: 6.6 (1.3-19.6) vs. 3.5 (0.8-12.1), p<0.001 and 3625 (1046-12,776) vs. 2158 (774-6759), p<0.001. Patients with LT3S had significantly higher rate of in-hospital CV death than those without (4.7% vs. 1.7%, p=0.005). Lower levels of fT3 yielded an area under the curve (AUC) of 0.741 for predicting CV death. LT3S, when added to the TIMI risk score, significantly increased AUC for in-hospital CV death than TIMI risk score alone (0.775 vs. 0.738, p=0.005). CONCLUSIONS LT3S was associated with more severe myocardial injury and increased in-hospital CV mortality in patients with AMI. Furthermore, it improved risk prediction of in-hospital CV death post-AMI when it was added to the TIMI risk score.
Collapse
Affiliation(s)
- Wen Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Man Wang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
| |
Collapse
|
358
|
Zhang K, Meng X, Wang W, Zheng J, An S, Wang S, Qi Y, Gao C, Tang YD. Prognostic Value of Free Triiodothyronine Level in Patients With Hypertrophic Obstructive Cardiomyopathy. J Clin Endocrinol Metab 2018; 103:1198-1205. [PMID: 29304228 DOI: 10.1210/jc.2017-02386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 01/01/2023]
Abstract
CONTEXT Thyroid hormone acts as a fundamental regulator in cardiovascular homeostasis in pathophysiological conditions. OBJECTIVE This study aims to determine whether thyroid hormone could be an independent predictor of adverse events in patients with hypertrophic obstructive cardiomyopathy (HOCM). DESIGN, PATIENTS, AND OUTCOME MEASURES The original cohort consisted of 965 consecutive patients with HOCM who were admitted to Fuwai Hospital from October 2009 to December 2014, and 756 patients completed thyroid function evaluations. Patients were divided into three groups according to free triiodothyronine (FT3) levels: tertile 1 (<2.81 pg/mL, n = 247), tertile 2 (2.81 to 3.11 pg/mL, n = 250), tertile 3 (3.12 to 4.09 pg/mL, n = 259). RESULTS In correlation analysis, FT3 showed significantly positive correlation with left ventricular ejection fraction (r = 0.109, P = 0.003). After a median follow-up of 44 months, a total of 45 (6.0%) endpoints (all-cause mortality or cardiac transplantation) occurred with rates of 13.4%, 3.6%, and 1.2% in tertiles 1, 2, and 3, respectively. Univariate Cox analysis established FT3 as a predictor of endpoint [hazard ratio (HR), 0.111; 95% confidence interval (CI), 0.065, 0.189; P < 0.001]. After adjustment for traditional risk factors, the prognostic value of FT3 level was still significant (HR, 0.216; 95% CI, 0.083, 0.559; P = 0.002). Compared with patients in tertile 3, those in tertile 1 were at a much higher risk of endpoint (HR, 4.918; 95% CI, 1.076, 22.485; P = 0.040). CONCLUSIONS FT3 correlated with cardiac function and could serve as an independent predictor of all-cause mortality and cardiac transplantation in patients with HOCM. These results suggest that monitoring thyroid function in HOCM patients is necessary.
Collapse
Affiliation(s)
- Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangbin Meng
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jilin Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shimin An
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Qi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yi-Da Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
359
|
El-Harasis MA, DeSimone CV, Stan MN, McLeod CJ, Noseworthy PA. Graves' disease–induced complete heart block and asystole. HeartRhythm Case Rep 2018; 4:105-108. [PMID: 29707485 PMCID: PMC5918183 DOI: 10.1016/j.hrcr.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
360
|
Wei SB, Wang W, Liu N, Chen J, Guo XY, Tang RB, Yu RH, Long DY, Sang CH, Jiang CX, Li SN, Wen SN, Wu JH, Bai R, Du X, Dong JZ, Ma CS. U-shaped association between serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol 2018; 51:263-270. [PMID: 29480346 DOI: 10.1007/s10840-018-0337-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Thyroid dysfunction affects the outcomes of atrial fibrillation (AF) catheter ablation. However, it remains unclear if the variations in thyroid function, especially in the triiodothyronine levels, are associated with AF recurrence in euthyroid subjects. This study investigated the associations of thyroid hormone levels with arrhythmia recurrence after AF catheter ablation in euthyroid patients. METHODS A total of 1115 consecutive AF patients who underwent catheter ablation were prospectively enrolled and had their thyroid function measured prior to the procedure. The serum free triiodothyronine (FT3), free tetraiodothyronine (FT4), and thyroid-stimulating hormone (TSH) levels were assessed as predictors of recurrence and were adjusted for potential confounders. The subjects were divided into five quintile groups according to the FT3, FT4, and TSH levels, respectively. RESULTS After a median follow-up of 723 days (interquartile range, 180-1070), 47.2% of patients experienced recurrence. After multivariate adjustment, subject in the lowest and highest FT3 quintiles showed increased risk of recurrence (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.26-2.03, P < 0.01, and HR 1.47, 95% CI 1.16-1.87, P < 0.01, respectively), compared to the median quintile of FT3 levels. Regarding the FT4 level, the highest quintile group showed a higher risk of recurrence (HR 1.27, 95% CI 1.01-1.60, P = 0.04). The TSH levels were not associated with AF recurrence. CONCLUSIONS Both high and low FT3 levels were associated with AF recurrence after catheter ablation. High-normal FT4 levels were also related to AF recurrence; however, no association was found between normal TSH levels and AF recurrence.
Collapse
Affiliation(s)
- Shao-Bin Wei
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ji Chen
- School of Statistics, East China Normal University, 500 Dongchuan Road, Shanghai, 200241, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
361
|
Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J 2018; 13:55-59. [PMID: 28740582 DOI: 10.14797/mdcj-13-2-55] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters.
Collapse
|
362
|
Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism and hypertension: fact or myth? - Authors' reply. Lancet 2018; 391:30. [PMID: 29323655 DOI: 10.1016/s0140-6736(17)33321-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Layal Chaker
- Academic Centre for Thyroid Disease, Erasmus University Medical Centre, Rotterdam 3015 CE, Netherlands
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
| | | | - Robin P Peeters
- Academic Centre for Thyroid Disease, Erasmus University Medical Centre, Rotterdam 3015 CE, Netherlands.
| |
Collapse
|
363
|
Santos EHS, dos Santos PJ, Santos IDS. Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a narrative review. SAO PAULO MED J 2018; 136:64-72. [PMID: 29590246 PMCID: PMC9924175 DOI: 10.1590/1516-3180.2017.0272141017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/14/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Carotid intima-media thickness (CIMT), as measured by ultrasound, has been used in large studies as a non-invasive marker for subclinical atherosclerosis. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort of 15,105 civil servants in six Brazilian cities that included CIMT evaluation in its baseline assessment. The aim of the present narrative review was to provide an overview of ELSA-Brasil CIMT articles published up to July 31, 2017. DESIGN AND SETTING Narrative review of ELSA-Brasil CIMT studies using baseline assessment data. METHODS We searched PubMed for the terms "ELSA-Brasil" and "intima-media". This search yielded 21 published articles using CIMT data from the ELSA-Brasil baseline assessment, which were included in this review. We also present information about intima-media thickness assessment from ongoing onsite reevaluations of the study participants. RESULTS Most published studies focused on the association with traditional and novel cardiovascular risk factors. Studies also presented information about the ELSA-Brasil CIMT protocol at baseline and CIMT value distribution in this large sample. CONCLUSIONS Analyses on the ELSA-Brasil data led to important insights on CIMT interpretation and physiology. Besides the highlighted contributions which have already been made in this field, new data gathered during the ongoing third onsite assessment will enable investigation of substantially new research questions.
Collapse
Affiliation(s)
- Eduardo Henrique Sena Santos
- MD. Physician, Imaging Service, and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário (HU), Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Pedro José dos Santos
- MD. Physician, Imaging Service, and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário (HU), Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Itamar de Souza Santos
- MD, PhD. Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário (HU), Universidade de São Paulo (USP), and Associate Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
| |
Collapse
|
364
|
Masullo LF, Magalhães RA, Lemes RPG, de Almeida Filho TP, de Castro MF, Maia Filho PA, Cunha TOV, Quidute ARP, Fontenele EGP, Sun G, Martins MRA. Levothyroxine Replacement Improves Oxidative Status in Primary Hypothyroidism. Front Endocrinol (Lausanne) 2018; 9:655. [PMID: 30467493 PMCID: PMC6235903 DOI: 10.3389/fendo.2018.00655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Although hypothyroidism has been linked to oxidative stress, data regarding the relationship between thyroid hormone levels and oxidative stress is still inconsistent. This study was designed to evaluate the effect of levothyroxine replacement on oxidative stress in women with primary hypothyroidism. Design: A total of 25 female patients with primary hypothyroidism were included. Oxidative stress markers were measured before and after levothyroxine replacement treatment in all patients. Methods: Oxidative stress was evaluated through the measurement of oxidants (thiobarbituric acid reactive substances [TBARS] and nitrite/nitrate levels), and antioxidants (superoxide dismutase and catalase activity). Results: Antioxidant catalase activity (63.77 ± 23.8 vs. 50.12 ±12.75 atv/min; p = 0.03) was significantly increased and the levels of TBARS (3.02 ± 0.86 vs. 3.55 ± 0.87 μM; p = 0.03) were significantly decreased in the state of euthyroidism after levothyroxine replacement compared to the hypothyroidism before levothyroxine treatment. No significant change in neither nitrite/nitrate concentration (p = 0.18) nor in superoxide dismutase activity (p = 0.93) after L-T4 adjustment was found. Conclusions: Our data demonstrate that levothyroxine replacement improved oxidative status in patients with primary hypothyroidism, indexed by the significantly decreased levels of malonaldehyde (MDA) and increased catalase (CAT) activity.
Collapse
Affiliation(s)
- Laís Farias Masullo
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Rejane Araújo Magalhães
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
| | - Romélia Pinheiro Gonçalves Lemes
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Tarcísio Paulo de Almeida Filho
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | - Marilena Facundo de Castro
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
| | - Pedro Aurio Maia Filho
- Research Laboratory in Haemoglobinopathies and Genetics of Haematological Diseases, Federal University of Ceará, Fortaleza, Brazil
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
| | | | - Ana Rosa Pinto Quidute
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Brazil
- Drug Research and Development Center-NPDM/Fortaleza, Fortaleza, Brazil
| | - Eveline Gadelha Pereira Fontenele
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Guang Sun
- Discipline of Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Manoel Ricardo Alves Martins
- Post-Graduate Program in Pathology, Federal University of Ceará, Fortaleza, Brazil
- Division of Endocrinology and Diabetes, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Brazil
- Drug Research and Development Center-NPDM/Fortaleza, Fortaleza, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- *Correspondence: Manoel Ricardo Alves Martins
| |
Collapse
|
365
|
Mujer, corazón y tiroides. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
366
|
Langén VL, Niiranen TJ, Puukka P, Lehtonen AO, Hernesniemi JA, Sundvall J, Salomaa V, Jula AM. Thyroid-stimulating hormone and risk of sudden cardiac death, total mortality and cardiovascular morbidity. Clin Endocrinol (Oxf) 2018; 88:105-113. [PMID: 28862752 DOI: 10.1111/cen.13472] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/10/2017] [Accepted: 08/27/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous data on the association of thyroid function with total mortality, cardiovascular disease (CVD) outcomes and sudden cardiac death (SCD) are conflicting or limited. We investigated associations of thyroid-stimulating hormone (TSH) with these outcomes in a nationwide population-based prospective cohort study. METHODS We examined 5211 participants representative of the Finnish population aged ≥30 years in 2000-2001 and followed them for a median of 13.2 years. Using Cox proportional hazards regression models adjusted for baseline age, gender, smoking, diabetes, systolic blood pressure and total and high-density lipoprotein cholesterol, we assessed the associations of continuous baseline TSH and TSH categories (low [<0.4 mU/L], reference range [0.4-3.4 mU/L] and high [>3.4 mU/L]) with incident total mortality, SCD, coronary heart disease events, stroke, CVD, major adverse cardiac events and atrial fibrillation. RESULTS High TSH at baseline was related to a greater risk of total mortality (HR 1.34, 95% CI 1.02-1.76) and SCD (HR 2.28, 95% CI 1.13-4.60) compared with TSH within the reference range. High TSH was not associated with the other outcomes (P ≥ .51), whereas low TSH was not associated with any of the outcomes (P ≥ .09). TSH at baseline over the full range did not have a linear relation with any of the outcomes (P ≥ .17). TSH showed a U-shaped association with total mortality after a restricted cubic spline transformation (P = .01). CONCLUSIONS Thyroid function abnormalities could be linked with higher risks of total mortality and SCD. Large-scale randomized studies are needed for evidence-based recommendations regarding treatment of mild thyroid failure.
Collapse
Affiliation(s)
- Ville L Langén
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Teemu J Niiranen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- The Framingham Heart Study, Framingham, MA, USA
| | - Pauli Puukka
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Arttu O Lehtonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku, Finland
| | - Jussi A Hernesniemi
- Faculty of Medicine and Life Sciences, University of Tampere and Heart Centre, Tampere University Hospital, Tampere, Finland
| | - Jouko Sundvall
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Antti M Jula
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
367
|
van der Spek AH, Fliers E, Boelen A. The classic pathways of thyroid hormone metabolism. Mol Cell Endocrinol 2017; 458:29-38. [PMID: 28109953 DOI: 10.1016/j.mce.2017.01.025] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/21/2016] [Accepted: 01/17/2017] [Indexed: 12/15/2022]
Abstract
Thyroid hormones (TH) are crucial for growth and development and play an important role in energy homeostasis. Although serum TH levels are relatively constant in the physiological state, TH bioavailability at the tissue and cellular level is dependent on local TH metabolism. Circulating TH produced by the thyroid can be metabolized by a number of different pathways resulting in 1) activation of TH 2) deactivation of TH or 3) excretion of TH and subsequent metabolites. These pathways play an essential role in determining local TH levels and action. The major classical pathways of TH metabolism are deiodination, sulfation, glucuronidation, and ether-link cleavage. This review provides an overview of these pathways, their relative contributions to TH levels in the serum and in various organs and the changes in these pathways elicited by fasting and illness.
Collapse
Affiliation(s)
- Anne H van der Spek
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
368
|
Sumler M, Vadlamudi R. Preanesthetic evaluation of the patient with end-stage heart failure. Best Pract Res Clin Anaesthesiol 2017; 31:179-188. [PMID: 29110791 DOI: 10.1016/j.bpa.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/10/2017] [Accepted: 06/16/2017] [Indexed: 11/15/2022]
Abstract
Heart failure (HF) currently affects more than 5 million patients in the United States [1]. Advanced HF is associated with high mortality and poor quality of life. It is estimated that between 5% and 10% of all patients with HF have an advanced form of the disease [1]. Orthotopic heart transplantation (OHT) is an accepted therapy for stage D HF [3] (Fig. 1). Unfortunately, the number of patients with the disease exceeds the number of available organs. This makes appropriate patient selection vital in the field of heart transplantation. Anesthetic evaluation of the patient presenting for OHT or mechanical circulatory support (MCS) implantation is a vital component of the patient's perioperative course. Patients often have had extensive diagnostic testing and assessment prior to being listed for OHT or considered for MCS implantation. Because of the often urgent nature of these procedures, the cardiac anesthesiologist must conduct a focused review of the relevant information and perform a focused patient interview and physical exam.
Collapse
Affiliation(s)
- Michele Sumler
- Emory University, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, United States.
| | - Ratna Vadlamudi
- Emory University, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, United States.
| |
Collapse
|
369
|
Peliciari-Garcia RA, Bargi-Souza P, Young ME, Nunes MT. Repercussions of hypo and hyperthyroidism on the heart circadian clock. Chronobiol Int 2017; 35:147-159. [PMID: 29111822 DOI: 10.1080/07420528.2017.1388253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Myocardial gene expression and metabolism fluctuate over the course of the day in association with changes in energy supply and demand. Time-of-day-dependent oscillations in myocardial processes have been linked to the intrinsic cardiomyocyte circadian clock. Triiodothyronine (T3) is an important modulator of heart metabolism and function. Recently, our group has reported time-of-day-dependent rhythms in cardiac T3 sensitivity, as well as, T3-mediated acute alterations on core clock components. Hypo and hyperthyroidism are the second most prevalent endocrine disease worldwide. Considering the importance of the cardiomyocyte circadian clock and T3 to cardiac physiology, the aim of this study was to investigate the consequences of chronic hypo and hyperthyroidism on 24-h rhythms of circadian clock genes in the heart. Hypo and hyperthyroidism was induced in rats by thyroidectomy (Tx) and i.p. injections of supraphysiological dose of T3, respectively. Here we report alterations in mRNA levels of the major core clock components (Bmal1, Per2, Nr1d1, and Rora) for both experimental conditions (with the exception of Per2 during hyperthyroid condition). Oscillations in mRNA levels of key glucose and fatty-acid metabolism genes known to be clock controlled (Pdk4, Ucp3, Acot1, and Cd36) were equally affected by the experimental conditions, especially during the hypothyroid state. These findings suggest that chronic alterations in thyroid status significantly impacts 24-h rhythms in circadian clock and metabolic genes in the heart. Whether these perturbations contribute toward the pathogenesis of cardiac dysfunction associated with hypo and hyperthyroidism requires further elucidation.
Collapse
Affiliation(s)
- Rodrigo A Peliciari-Garcia
- a Morphophysiology & Pathology Sector, Department of Biological Sciences , Federal University of São Paulo , Diadema , Brazil.,b Department of Physiology and Biophysics , Institute of Biomedical Sciences-I, University of São Paulo , São Paulo , Brazil
| | - Paula Bargi-Souza
- b Department of Physiology and Biophysics , Institute of Biomedical Sciences-I, University of São Paulo , São Paulo , Brazil
| | - Martin E Young
- c Division of Cardiovascular Diseases, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Maria Tereza Nunes
- b Department of Physiology and Biophysics , Institute of Biomedical Sciences-I, University of São Paulo , São Paulo , Brazil
| |
Collapse
|
370
|
Peixoto de Miranda ÉJF, Bittencourt MS, Staniak HL, Pereira AC, Foppa M, Santos IS, Lotufo PA, Benseñor IM. Thyrotrophin levels and coronary artery calcification: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clin Endocrinol (Oxf) 2017; 87:597-604. [PMID: 28609552 DOI: 10.1111/cen.13393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE There is little information about the association between thyrotrophin (TSH) levels and coronary artery calcification (CAC). Our aim was to analyse the association between TSH quintiles and subclinical atherosclerosis measured by CAC, using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN Cross-sectional study. PATIENTS We excluded individuals using medications that affect thyroid function and who self-reported cardiovascular disease. We included euthyroid subjects and individuals with subclinical hypothyroidism (SCHypo) and subclinical hyperthyroidism (SCHyper). Logistic regression models evaluated CAC >100 Agatston units as the dependent variable, and increasing quintiles of TSH as the independent variable, adjusted for demographic and cardiovascular risk factors. RESULTS Our sample included 3836 subjects, mean age 49 years (interquartile range 44-56); 1999 (52.1%) were female, 3551 (92.6%) were euthyroid, 239 (6.2%) had SCHypo and 46 (1.2%) had SCHyper. The frequency of women, White people and never smokers as well as body mass index and insulin resistance increased according to quintiles. The 1st quintile for TSH (0-0.99 mIU/L) was associated with CAC >100, using the 3rd quintile (1.39-1.85 mIU/L) as reference (adjusted OR=1.57, 95% CI: 1.05-2.35, P=.027), but no association was shown for the 5th quintile (2.68-35.5 mIU/L) compared to the 3rd. Restricting the analysis to euthyroid subjects did not change the results. For women, but not for men, we observed a U-shaped curve with 1st and 5th TSH quintiles associated with CAC>100. CONCLUSION Low and low-normal (1st quintile) TSH levels were associated with CAC>100 Agatston units in a sample with subclinical thyroid disorders and euthyroid subjects.
Collapse
Affiliation(s)
| | | | - Henrique Lane Staniak
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | | | - Murilo Foppa
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Itamar S Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
371
|
Desideri G, Bocale R, D'Amore A, Necozione S, Boscherini M, Carnassale G, Barini A, Barini A, Bellantone R, Lombardi CP. Replacement therapy with levothyroxine modulates platelet activation in recent-onset post-thyroidectomy subclinical hypothyroidism. Nutr Metab Cardiovasc Dis 2017; 27:896-901. [PMID: 28964662 DOI: 10.1016/j.numecd.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/04/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM Subclinical hypothyroidism has been linked to increased risk of atherosclerotic disease. Soluble CD40 ligand (sCD40L), mainly derived from activated platelets, and the lipid peroxidation product 8-iso-prostaglandin F2α (8-iso-PGF2α) are known to play a relevant pathophysiological role in atherogenesis. In this study, we analyzed the relationship between thyroid hormones and circulating levels of sCD40L and 8-iso-PGF2α in patient with recent-onset post-thyroidectomy subclinical hypothyroidism under replacement therapy. METHODS AND RESULTS Circulating levels of thyroid hormones, sCD40L, and 8-iso-PGF2α were assessed in 40 recently thyroidectomized patients (33 females, mean age 52.0 ± 11.7 years) at baseline (5-7 day after surgery) and after 2 months under replacement therapy with levothyroxine (LT-4). At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 7.7 ± 3.9 μU/mL, FT3 1.8 ± 0.6 pg/mL, and FT3 8.9 ± 3.0 pg/mL). Circulating levels of sCD40L and 8-iso-PGF2α were directly correlated with each other (r = 0.360, p = 0.023) and with TSH levels (r = 0.322, p = 0.043 and r = 0.329 p = 0.038, respectively). After 2 months under the replacement therapy with LT-4 circulating levels of TSH (from 7.7 ± 3.9 to 2.7 ± 2.8 μU/mL, p < 0.0001), sCD40L (from 6.11 ± 2.41 to 2.43 ± 2.00 ng/mL, p < 0.0001) and 8-iso-PGF2α (from 45.33 ± 6.94 to 40.36 ± 6.20, p < 0.0001) significantly decreased. Changes in circulating levels of sCD40L and 8-iso-PGF2α were directly correlated with each other (r = 0.349 p = 0.028) and with changes in TSH levels (r = 0.367 p = 0.020 and r = 0.339 p = 0.032, respectively). CONCLUSION Our study suggests an influential role of TSH on proatherogenic activation of platelets, probably through enhanced lipid peroxidation. These findings could partially explain the increased susceptibility of patients with subclinical hypothyroidism to develop atherosclerotic disease.
Collapse
Affiliation(s)
- G Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - R Bocale
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A D'Amore
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Boscherini
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Carnassale
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Barini
- Institute of Biochemistry and Clinical Biochemistry, Department of Laboratory Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Barini
- Institute of Biochemistry and Clinical Biochemistry, Department of Laboratory Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bellantone
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C P Lombardi
- Division of Endocrine and Metabolic Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
372
|
Journy NM, Bernier MO, Doody MM, Alexander BH, Linet MS, Kitahara CM. Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women. Thyroid 2017; 27:1001-1010. [PMID: 28578598 PMCID: PMC5564026 DOI: 10.1089/thy.2017.0063] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up. METHODS The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors. RESULTS During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to ≥10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases. CONCLUSION The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications.
Collapse
Affiliation(s)
- Neige M.Y. Journy
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marie-Odile Bernier
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Laboratoire d'épidémiologie des rayonnements ionisants, Service de Radiobiologie et d'Epidémiologie, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Michele M. Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
373
|
Recovery following Thyroxine Treatment Withdrawal, but Not Propylthiouracil, Averts In Vivo and Ex Vivo Thyroxine-Provoked Cardiac Complications in Adult FVB/N Mice. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6071031. [PMID: 28791308 PMCID: PMC5534272 DOI: 10.1155/2017/6071031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 12/23/2022]
Abstract
Persistent cardiovascular pathology has been described in hyperthyroid patients even with effective antithyroid treatment. Here, we studied the effect of a well-known antithyroid drug, propylthiouracil (PTU; 20 mg/kg/day), on thyroxine (T4; 500 µg/kg/day)-induced increase in blood pressure (BP), cardiac hypertrophy, and altered responses of the contractile myocardium both in vivo and ex vivo after 2 weeks of treatment. Furthermore, the potential recovery through 2 weeks of T4 treatment discontinuation was also investigated. PTU and T4 recovery partially reduced the T4-prompted increase in BP. Alternatively, PTU significantly improved the in vivo left ventricular (LV) function with no considerable effects on cardiac hypertrophy or ex vivo right ventricular (RV) contractile alterations subsequent to T4 treatment. Conversely, T4 recovery considerably enhanced the T4-provoked cardiac changes both in vivo and ex vivo. Altogether, our data is in agreement with the proposal that hyperthyroidism-induced cardiovascular pathology could persevere even with antithyroid treatments, such as PTU. However, this cannot be generalized and further investigation with different antithyroid treatments should be executed. Moreover, we reveal that recovery following experimental hyperthyroidism could potentially ameliorate cardiac function and decrease the risk for additional cardiac complications, yet, this appears to be model-dependent and should be cautiously construed.
Collapse
|
374
|
Nik N, Fong A, Derdzakyan M, Adamopoulou C, Sise A, Khanifar A, Sanders R. Changes in Choroidal Perfusion after Orbital Decompression Surgery for Graves' Ophthalmopathy. J Ophthalmic Vis Res 2017; 12:183-186. [PMID: 28540010 PMCID: PMC5423372 DOI: 10.4103/jovr.jovr_165_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To assess choroidal perfusion before and after orbital decompression surgery in patients with Graves' ophthalmopathy. Methods: In this interventional case series, surgical decompression for optic nerve compromise was performed on four eyes of three patients with Graves' disease. Complete ophthalmic examination including visual acuity, color vision, and intraocular pressure assessment were done pre- and postoperatively. High-speed indocyanine green angiography was performed prior to surgery and was repeated one year after surgery. Results: In all three patients, choroidal perfusion defects were noted pre-operatively in the eyes with the compressive optic neuropathy. At 1 year after orbital decompression surgery, the defects improved or completely resolved. Improved visual acuity and color perception, as well as decreased intraocular pressure, were also noted postoperatively. Conclusion: Patients with Graves' orbitopathy may have abnormal choroidal perfusion even in the absence of optic neuropathy. Orbital decompression may improve choroidal circulation in these patients.
Collapse
Affiliation(s)
- Narieman Nik
- Department of Ophthalmology and Visual Sciences, Georgetown University/MedStar Washington Hospital Center, Washington, DC, USA
| | - Amelia Fong
- Department of Ophthalmology and Visual Sciences, Georgetown University/MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | - Adam Sise
- Private Practice, Eyecare Medical Group, Portland, Maine, USA
| | - Aziz Khanifar
- Private Practice, Retina Group of Washington, Chevy Chase, Maryland, USA
| | - Reginald Sanders
- Private Practice, Retina Group of Washington, Chevy Chase, Maryland, USA
| |
Collapse
|
375
|
Rajagopalan V, Zhang Y, Pol C, Costello C, Seitter S, Lehto A, Savinova OV, Chen YF, Gerdes AM. Modified Low-Dose Triiodo-L-thyronine Therapy Safely Improves Function Following Myocardial Ischemia-Reperfusion Injury. Front Physiol 2017; 8:225. [PMID: 28446882 PMCID: PMC5388763 DOI: 10.3389/fphys.2017.00225] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
Background: We have shown that thyroid hormones (THs) are cardioprotective and can be potentially used as safe therapeutic agents for diabetic cardiomyopathy and permanent infarction. However, no reliable, clinically translatable protocol exists for TH treatment of myocardial ischemia-reperfusion (IR) injury. We hypothesized that modified low-dose triiodo-L-thyronine (T3) therapy would confer safe therapeutic benefits against IR injury. Methods: Adult female rats underwent left coronary artery ligation for 60 min or sham surgeries. At 2 months following surgery and T3 treatment (described below), the rats were subjected to functional, morphological, and molecular examination. Results: Following surgery, the rats were treated with T3 (8 μg/kg/day) or vehicle in drinking water ad libitum following IR for 2 months. Oral T3 significantly improved left ventricular (LV) contractility, relaxation, and relaxation time constant, and decreased beta-myosin heavy chain gene expression. As it takes rats ~6 h post-surgery to begin drinking water, we then investigated whether modified T3 dosing initiated immediately upon reperfusion confers additional improvement. We injected an intraperitoneal bolus of T3 (12 μg/kg) upon reperfusion, along with low-dose oral T3 (4.5 μg/kg/day) in drinking water for 2 months. Continuous T3 therapy (bolus + low-dose oral) enhanced LV contractility compared with oral T3 alone. Relaxation parameters were also improved compared to vehicle. Importantly, these were accomplished without significant increases in hypertrophy, serum free T3 levels, or blood pressure. Conclusions: This is the first study to provide a safe cardiac therapeutic window and optimized, clinically translatable treatment-monitoring protocol for myocardial IR using commercially available and inexpensive T3. Low-dose oral T3 therapy supplemented with bolus treatment initiated upon reperfusion is safer and more efficacious.
Collapse
Affiliation(s)
- Viswanathan Rajagopalan
- Department of Basic Sciences, New York Institute of Technology-College of Osteopathic MedicineJonesboro, AR, USA.,Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Christine Pol
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Clifford Costello
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Samantha Seitter
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Ann Lehto
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Olga V Savinova
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - Yue-Feng Chen
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic MedicineOld Westbury, NY, USA
| |
Collapse
|
376
|
Gao X, Chen Z, Liu M, Jia YM, Yang N, Yao Z, Feng XM, Xu Y, Wang G. Effects of short-term levothyroxine therapy on myocardial injuries in patients with severe overt hypothyroidism: Evidence from a cardiac MRI Study. J Magn Reson Imaging 2017; 46:897-904. [PMID: 28323379 DOI: 10.1002/jmri.25628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/21/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Xia Gao
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Zhe Chen
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Min Liu
- Department of Radiology; China-Japan Friendship Hospital; Beijing P.R. China
| | - Yu-Mei Jia
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Ning Yang
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Zhi Yao
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Xiao-Meng Feng
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| | - Guang Wang
- Department of Endocrinology, Beijing Chaoyang Hospital; Capital Medical University; Beijing P.R. China
| |
Collapse
|
377
|
Vargas-Uricoechea H, Bonelo-Perdomo A. Thyroid Dysfunction and Heart Failure: Mechanisms and Associations. Curr Heart Fail Rep 2017; 14:48-58. [DOI: 10.1007/s11897-017-0312-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|