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Dogdus M, Diker S, Yenercag M, Gurgun C. Evaluation of left atrial and ventricular myocardial functions by three-dimensional speckle tracking echocardiography in patients with euthyroid Hashimoto's thyroiditis. Int J Cardiovasc Imaging 2020; 37:459-465. [PMID: 32897525 DOI: 10.1007/s10554-020-02011-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Hashimoto's Thyroiditis (HsT) is one of the most frequently occurring autoimmune diseases, characterized by lymphocytic infiltration, destruction and fibrosis of thyroid tissue and the presence of antibodies to thyroid peroxidase and thyroglobulin. The effects of euthyroid Hashimoto's thyroiditis (eHsT) on cardiovascular system are unclear. We aimed to identify if any deteriorations in LA and LV myocardial functions in patients with eHsT by 3D-STE in the current study. Fifty eight patients with eHsT and 60 age- and gender-matched controls were enrolled into the study. All participants underwent laboratory analyses which included thyroid hormones and thyroid autoantibody levels; and conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the study patients was 34.5 ± 9 years, and 68.6% were female. Left ventricular global longitudinal strain (LV-GLS) was significantly depressed in the eHsT (+) group than in the control group (- 15.3 ± 3.6 vs. - 22.8 ± 3.8, p < 0.001). The LV-GLS was found to be disrupted linearly as thyroid autoantibodies increased (r = 0.684 for anti-TPO-ab and LV-GLS; r = 0.649 for anti-Tg-ab and LV-GLS). The present study demonstrated that 3D-STE is useful in the early detection of LV myocardial dysfunction in patients with eHsT. We found that eHsT had a negative effect on LV myocardial dynamics. According to these findings, these myocardial alterations that are present early in the disease process may be considered as a reason to start medical treatment earlier, even at the euthyroid stage to prevent LV myocardial impairment.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Training and Research Hospital, Usak University, 64100, Usak, Turkey.
| | - Suleyman Diker
- Department of Internal Medicine, Training and Research Hospital, Usak University, 64100, Usak, Turkey
| | - Mustafa Yenercag
- Department of Cardiology, Faculty of Medicine, Ordu University, 52200, Ordu, Turkey
| | - Cemil Gurgun
- Department of Cardiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
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Disoteo OE, Zampetti B, Garascia A, Attanasio R, Cozzi R. Autoimmune Polyendocrine Syndrome Complicated by Pulmonary Hypertension. Endocr Metab Immune Disord Drug Targets 2020; 21:561-565. [PMID: 32744953 DOI: 10.2174/1871530320666200801033106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 11/22/2022]
Abstract
A 24-years old female was admitted for acute renal failure, melanoderma, hyponatremia, and hyperkalemia. The clinical suspicion of Addison's disease was confirmed by laboratory test and the appropriate replacement therapy with corticosteroids and fludrocortisone was started. In the meantime primary hypothyroidism and diabetes mellitus type 1 were disclosed and treated, thus fulfilling a diagnosis of autoimmune polyendocrine syndrome type 2. Eighteen months later she was admitted for right-sided heart failure. The work-up allowed to diagnose pulmonary arterial hypertension. Here, we report the clinical course and discuss the putative link between these two rare diseases.
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Affiliation(s)
- Olga E Disoteo
- ASST Grande Ospedale Metropolitano Niguarda, Diabetology Unit, Milan, Italy
| | - Benedetta Zampetti
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan, Italy
| | - Andrea Garascia
- ASST Grande Ospedale Metropolitano Niguarda, Cardiology Unit, Milan, Italy
| | - Roberto Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy
| | - Renato Cozzi
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan, Italy
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Azak E, Uçaktürk SA, Çetin İİ, Gürsu HA, Mengen E, Pamuk U. Subclinical Myocardial Dysfunction Demonstrated by Speckle Tracking Echocardiography in Children with Euthyroid Hashimoto’s Thyroiditis. J Clin Res Pediatr Endocrinol 2019; 11:410-418. [PMID: 31218876 PMCID: PMC6878337 DOI: 10.4274/jcrpe.galenos.2019.2018.0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Thyroid hormones have an important role in the regulation of the cardiovascular system. The aim of this study was to investigate the presence of subclinical myocardial dysfunction in children with euthyroid Hashimoto’s thyroiditis (eHT) without evident heart disease using tissue doppler imaging (TDI) and speckle tracking echocardiography (STE) methods. Methods TDI and STE were peformed in 50 children with eHT and in 35 healthy children. To assess myocardial velocities and time intervals, including peak systolic velocity (Sm), peak early diastolic velocity (Em), peak late diastolic velocity (Am), isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET), TDI was performed at the base of the interventricular septum (IVS) and in the left and right ventricles (LV and RV, respectively). Analysis of myocardial deformation by STE including strain (S) and strain rate (SR) was performed globally in two planes, longitudinal (L) and mid-circumferential (C) in LV [LV global longitudinal strain (LVGLS), LV global longitudinal strain rate (LVGLSR), LV global circumferential strain (LVGCS), LV global circumferential strain rate (LVGCSR)] and RV [(RV global longitudinal strain (RVGLS), RV global longitudinal strain rate (RVGLSR)]. Results Among TDI parameters, ET at LV and IVS were significantly lower, IVRT and myocardial performance index at LV and IVS were significantly higher in the eHT group compared to controls (p=0.001). There were no significant differences in Sm, Em, Am and IVCT values between patients and controls. LVGLS, LVGLSR, LVGCS and LVGCSR values were significantly lower in patients than controls (p=0.01). There was a negative correlation between thyroid antibody levels and LV global longitudinal and circumferential strain and strain rate values (TPO-Ab and Tg-Ab between LVGLS, LVGLSR, LVGCS and LVGCSR; r=-411, p<0.001; r=-541, p<0.001; r=-430, p<.0.001; r=-502, r<0.01 and r=-397, p<0.001; r=-473, p<0.001; r=-519, p<0.001; r=-421, p<0.00, respectively). Conclusion The results show that myocardial function in children with eHT is impaired in the absence of any clinical symptoms and that conventional echocardiography is inadequate to determine these changes.
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Affiliation(s)
- Emine Azak
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Seyit Ahmet Uçaktürk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - İbrahim İlker Çetin
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Hazım Alper Gürsu
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Eda Mengen
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Utku Pamuk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
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Rashidi F, Sate H, Faraji E, Tahsini Tekantapeh S. Thyrotoxicosis presenting as exertional dyspnea and pulmonary hypertension: Case report and review of literature. SAGE Open Med Case Rep 2017; 5:2050313X17715584. [PMID: 28680634 PMCID: PMC5480624 DOI: 10.1177/2050313x17715584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/22/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: In this case study, we describe a 35-year-old woman with pulmonary hypertension that was secondary to thyrotoxicosis who presented with exertional dyspnea. In the approach to exertional dyspnea, detailed physical examination and laboratory findings helped to get the diagnosis. Methods: Echocardiography showed right ventricular systolic pressure = 60 mmHg. A suppressed thyroid-stimulating hormone was seen in lab tests. The patient was treated with radioactive iodine. Results: Palpitations and shortness of breath improved, and both her thyroid-stimulating hormone and T4 levels decreased. Echocardiography and the pulmonary pressure were normal after treatment. Conclusions: Thyrotoxicosis is one of the etiologies of pulmonary hypertension, but the exact etiology and pathogenesis remain unknown. Some patients may have symptomatic pulmonary hypertension that can be resolved by hyperthyroidism treatment.
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Affiliation(s)
- Farid Rashidi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Sate
- Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmaeil Faraji
- Endocrine Research Center, Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Tahsini Tekantapeh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Imam Reza Hospital, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Wu B, Jiang J, Gui M, Liu L, Aleteng Q, Wang S, Liu X, Ling Y, Gao X. Serum-Free Thyroxine Levels Were Associated with Pulmonary Hypertension and Pulmonary Artery Systolic Pressure in Euthyroid Patients with Coronary Artery Disease. Int J Endocrinol 2017; 2017:4832608. [PMID: 28717364 PMCID: PMC5498901 DOI: 10.1155/2017/4832608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the association between thyroid hormone levels, pulmonary hypertension (PH), and pulmonary artery systolic pressure (PASP) in euthyroid patients with coronary artery disease (CAD). A cross-sectional study was conducted in individuals who underwent coronary angiography and were diagnosed as CAD from March 2013 to November 2013. 811 subjects (185 women and 626 men) were included in this study. PASP was measured by transthoracic Doppler echocardiography. 86 patients were diagnosed as PH and had significantly higher free thyroxine (FT4) levels than those without PH. Multiple logistic regression analysis demonstrated an independent association of FT4 levels with PH after adjustment of gender, age, body mass index, systolic blood pressure, left ventricular ejection fraction, hypertension, and medication use of calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, and nitrates. Serum-free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) were not associated with PH. Furthermore, multivariate linear regression analysis showed that FT4 levels emerged as an independent predictor for PASP, while FT3 and TSH levels were not associated with PASP. Our study demonstrated that, in euthyroid patients with CAD, FT4 was an independent risk factor for PH, and FT4 levels were independently associated with PASP.
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Affiliation(s)
- Bingjie Wu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Minghui Gui
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Lin Liu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Qiqige Aleteng
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Shanshan Wang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Xiaojing Liu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
- *Yan Ling: and
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
- *Xin Gao:
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Vatan MB, Varım C, Ağaç MT, Varım P, Çakar MA, Aksoy M, Erkan H, Yılmaz S, Kilic H, Gündüz H, Akdemir R. Echocardiographic Evaluation of Biventricular Function in Patients with Euthyroid Hashimoto's Thyroiditis. Med Princ Pract 2016; 25:143-9. [PMID: 26613523 PMCID: PMC5588360 DOI: 10.1159/000442709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/24/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients. SUBJECTS AND METHODS Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test. RESULTS Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group. CONCLUSIONS This study demonstrated that both RV and LV functions were impaired in patients with eHT.
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Affiliation(s)
- Mehmet Bülent Vatan
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
- *Mehmet Bülent Vatan, MD, Department of Cardiology, Sakarya University Training and Research Hospital, Adnan Menderes Street, TR—54000 Sakarya (Turkey), E-Mail
| | - Ceyhun Varım
- Department of Internal Medicine, Sakarya University Training and Research Hospital, Sakarya, Trabzon, Turkey
| | - Mustafa Tarık Ağaç
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Perihan Varım
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Mehmet Akif Çakar
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Murat Aksoy
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Hakan Erkan
- Department of Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Sabiye Yılmaz
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Harun Kilic
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Hüseyin Gündüz
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
| | - Ramazan Akdemir
- Department of Cardiology, Ahi Evren Cardiovascular Training and Research Hospital, Trabzon, Turkey
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Ciccone MM, Zito A, Ciampolillo A, Gesualdo M, Zaza P, Rodio M, Barbaro M, Di Molfetta S, Scicchitano P. Pulmonary hypertension and Hashimoto's thyroiditis: does a relationship exist? Endocrine 2015; 48:621-8. [PMID: 25060208 DOI: 10.1007/s12020-014-0358-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/05/2014] [Indexed: 12/16/2022]
Abstract
Several studies examined the possibility that idiopathic pulmonary hypertension is related to thyroid autoimmune diseases. The aim of our study was to highlight the possible correlations between the pulmonary hypertension and Hashimoto's thyroiditis (HT). A total of 93 patients were enrolled, 70 suffering from HT in euthyroidism state and 23 controls. All underwent anthropometric [weight (Kg); height (m); Body Mass Index (Kg/m(2)): waist circumference (cm)] and biochemical [fasting blood glucose (mg/dl), TSH (µUI/mL), FT3 (pg/ml), FT4 (pg/ml), total, HDL and LDL-cholesterol (mg/dl), triglycerides (mg/dl)] evaluations. All patients underwent two-dimensional trans-thoracic echocardiographic evaluations in order to measure systolic (sPAP) and the end-diastolic pressure of the pulmonary artery (dPAP). There were no differences between the two populations regarding anthropometric and biochemical parameters. Patients with HT had higher sPAP values than controls (Hashimoto: 20.06 ± 6.56 mmHg vs controls: 19.96 ± 8.58 mmHg, p = 0.044). Patients with HT had lower dPAP values than controls (2.51 ± 0.90 mmHg vs. controls 3.17 ± 1.58 mmHg, p < 0.0001), and there was a statistically significant difference in the left ventricle ejection fraction between the two groups (60.57 ± 1.60 % in patients with HT vs. 61.04 ± 2.03 % in controls, p = 0.037). The multivariate regression analysis did not confirm such results. We demonstrated that patients with HT did not show relevant pulmonary hypertension when compared to healthy controls.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, piazza G. Cesare, 11, 70124, Bari, Italy,
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Conradie M, Koegelenberg C, Conradie M, Ascott-Evans BH, Hough FS. Pulmonary hypertension and thyrotoxicosis. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2012.10872285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Conradie
- Divisions of Endocrinology, Department of Medicine, Stellenbosch University
| | - C Koegelenberg
- Divisions of Pulmonology, Department of Medicine, Stellenbosch University
| | - M Conradie
- Divisions of Endocrinology, Department of Medicine, Stellenbosch University
| | - BH Ascott-Evans
- Divisions of Endocrinology, Department of Medicine, Stellenbosch University
| | - FS Hough
- Divisions of Endocrinology, Department of Medicine, Stellenbosch University
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Abstract
Pulmonary hypertension is a complex disorder with multiple etiologies. The World Health Organization Group 5 (unclear multifactorial mechanisms) includes patients with thyroid disorders. The authors reviewed the literature on the association between hyperthyroidism and pulmonary hypertension and identified 20 publications reporting 164 patients with treatment outcomes. The systolic pulmonary artery (PA) pressures in these patients ranged from 28 to 78 mm Hg. They were treated with antithyroid medications, radioactive iodine and surgery. The mean pretherapy PA systolic pressure was 39 mm Hg; the mean posttreatment pressure was 30 mm Hg. Pulmonary hypertension should be considered in hyperthyroid patients with dyspnea. All patients with pulmonary hypertension should be screened for hyperthyroidism, because the treatment of hyperthyroidism can reduce PA pressures, potentially avoid the side-effects and costs with current therapies for pulmonary hypertension and limit the consequences of untreated hyperthyroidism. However, the long-term outcome in these patients is uncertain, and this issue needs more study. Changes in the pulmonary circulation and molecular regulators of vascular remodeling likely explain this association.
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Akgul E, Kutuk U, Ertek S, Cesur M, Cehreli S, Tore HF, Erdogan G. Cardiac Autonomic Function and Global Left Ventricular Performance in Autoimmune Eauthyroid Chronic Thyroiditis: Is Treatment Necessary at the Euthyroid Stage? Echocardiography 2011; 28:15-21. [DOI: 10.1111/j.1540-8175.2010.01240.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Current world literature. Curr Opin Rheumatol 2010; 23:125-30. [PMID: 21124095 DOI: 10.1097/bor.0b013e3283422cce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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