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Systemic and local cardiac thyroid function in euthyroid sick syndrome (a) and local cardiac hypothyroidism (b). a Euthyroid sick syndrome presenting with its key features: low T3 and high rT3 serum levels as well as normal TSH and low to normal T4 serum levels. Local cardiac T3 levels are decreased. b Local cardiac hypothyroidism presenting with a normal systemic thyroid function and increased D3 activity in the cardiac tissue leading to decreased local T3 and T4 levels (images obtained from Servier Medical Art)
Source publication
Cardiovascular diseases are the leading cause of death worldwide. Heart failure is the terminal manifestation of cardiovascular diseases, and its morbidity and mortality remain high. The prevalence of heart failure with preserved ejection fraction (HFpEF) among heart failure patients remains uncertain. However, recent studies have found that it ran...
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Citations
... That is essential for myocardial diastolic function. In addition, thyroid hormones also play a role in reducing peripheral resistance by promoting calcium reuptake in peripheral arterioles (8). So thyroid hormones also indirectly affect the heart by regulating cardiac preload and afterload (5). ...
... Thyroid dysfunction was also thought to be associated with a number of cardiovascular diseases, including heart failure, atrial fibrillation, coronary atherosclerosis (8)(9)(10)(11)(12)(13)(14), and cardiovascular allcause mortality (15). Therefore, a proper understanding of the impact of thyroid dysfunction on the myocardium can guide clinical practice and improve patient prognosis. ...
... This will increase the patient's susceptibility to heart failure, thereby affecting the patient's long-term prognosis. Subclinical hypothyroidism was also thought to be associated with coronary heart disease (8)(9)(10)(11)(12)(13)(14). However, most studies had small sample sizes, and some had mixed results. ...
Objective
The meta-analysis aimed to explore the cardiac adaptation in hypothyroidism patients by cardiac magnetic resonance.
Research methods and procedures
Databases including PubMed, Cochrane Library, Embase, CNKI, and Sinomed for clinical studies of hypothyroidism on cardiac function changes. Databases were searched from the earliest data to 15 June 2023. Two authors retrieved studies and evaluated their quality. Review Manager 5.4.1 and Stata18 were used to analyze the data. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202440114.
Results
Six studies were selected for further analysis. Five of them reported differences in cardiac function measures between patients with hypothyroidism and healthy controls, and three studies reported cardiac function parameters after treatment in patients with hypothyroidism. The fixed-effect model combined WMD values for left ventricular ejection fraction (LVEF) had a pooled effect size of -1.98 (95% CI -3.50 to -0.44], P=0.01), implying that LVEF was lower in patients with hypothyroidism than in healthy people. Analysis of heterogeneity found moderate heterogeneity (P = 0.08, I² = 50%). WMD values for stroke volume (SV), cardiac index (CI), left ventricular end-diastolic volume index(LVEDVI), left ventricular end-systolic volume (LESVI), and left ventricular mass index(LVMI) were also analyzed, and pooled effect sizes showed the CI and LVEDVI of patients with hypothyroidism ware significantly decrease (WMD=-0.47, 95% CI [-0.93 to -0.00], P=0.05, WMD=-7.99, 95%CI [-14.01 to -1.96], P=0.009, respectively). Patients with hypothyroidism tended to recover cardiac function after treatment [LVEF (WMD = 6.37, 95%CI [2.05, 10.69], P=0.004), SV (WMD = 7.67, 95%CI [1.61, 13.74], P=0.01), CI (WMD = 0.40, 95%CI [0.01, 0.79], P=0.05)], and there was no difference from the healthy controls.
Conclusion
Hypothyroidism could affect cardiac function, although this does not cause significant heart failure. It may be an adaptation of the heart to the hypothyroid state. There was a risk that this adaptation may turn into myocardial damage. Cardiac function could be restored after treatment in patients with hypothyroidism. Aggressive levothyroxine replacement therapy should be used to reverse cardiac function.
Systematic review registration
https://inplasy.com, identifier (INPLASY202440114).
... Dodatkowo utrzymanie homeostazy hormonów tarczycy jest konieczne dla prawidłowego funkcjonowania układu sercowo-naczyniowego (Gerdes and Iervasi, 2010;Vargas-Uricoechea et al., 2014). Hormony tarczycy działają bezpośrednio na transkrypcję specyficznych i niespecyficznych genów sercowych (Klein and Ojamaa, 2001;Vale et al., 2019), głównie trójjodotyronina (T3), która jest aktywną postacią hormonu tarczycy. Ze względu na lipofilowy charakter hormonów tarczycowych, mogą one łatwo dyfundować przez błonę cytoplazmatyczną kardiomiocytów, skąd lipofilowa T3 wchodzi do jądra i wiąże się z jądrowymi receptorami hormonów tarczycy, które następnie wiążą się z DNA i regulują ekspresję genów kodujących strukturalne i funkcjonalne białka sercowe, np. ...
The importance of thyroid hormones in maintaining homeostasis of the cardiovascular system can be inferred from clinical and experimental data showing that even subtle changes in thyroid hormone concentrations - such as those observed in subclinical hypothyroidism or hyperthyroidism and low triiodothyronine syndrome - adversely affect the cardiovascular system. Some potential mechanisms linking the two conditions are dyslipidemia, endothelial dysfunction, changes in blood pressure, and the direct effects of thyroid hormones on the myocardium. Purpose: analysis of changes in the concentration of markers of oxidative stress, e.g. oxidation of protein amino acid residues [concentration of aldehydic and ketonic derivatives of oxidatively modified proteins (OMP)] in the blood of individuals with hypothyroidism and/or myocardial infarcts, living in central Pomeranian region, depending on age, physical activity, smoking and the presence of myocardial infarcts and thyroid diseases in the family. Methodology. The level of oxidative stress markers was assessed among 225 individuals, i.e. 132 males (58.67%) and 93 females (41.33%) aged 35-71 years residing in central Pomeranian region. In the obtained blood, an assessment of levels of aldehydic and ketonic derivatives of oxidatively modified protein analyses was carried out. Scientific novelty. According to our research, the level of aldehydic derivatives of oxidative modification of proteins was significantly higher in the elderly (more than 55 years old), and the level of ketonic derivatives was higher in younger individuals (less than 55 years old) with myocardial infarction and with both myocardial infarction and hypothyroidism. This proves the intensification of oxidative stress in both presented diseases, both among the elderly and younger individuals. The highest level of aldehydic and ketonic derivatives of oxidative modification of proteins was noted among individuals with myocardial infarctions and hypothyroidism with low physical activity and among non-smokers who suffer from hypothyroidism and additionally suffered myocardial infarctions, which may indicate an increase in oxidative stress at these diseases, regardless of physical activity and smoking. The highest level of aldehydic derivatives was noted in the group of individuals with myocardial infarction and hypothyroidism with myocardial infarction in family history, which may indicate an increase in oxidative stress in both diseases, especially in this studied group. The highest level of oxidative modification of proteins was noted among individuals with myocardial infarction and hypothyroidism, individuals with thyroid diseases in their family history, as well as those with no thyroid diseases in their family history. This proves the intensification of oxidative stress in both presented diseases, regardless of the factor of thyroid diseases in the family history. Conclusions. In the course of myocardial infarction, the level of aldehydic derivatives of oxidatively modified proteins is affected by gender, while the level of ketonic derivatives of oxidatively modified proteins is affected by the presence of a myocardial infarction in the family history. The level of aldehydic derivatives of oxidative modification of proteins in individuals with hypothyroidism is influenced by low physical activity and age over 55, while the level of ketonic derivatives of oxidative modification of proteins is affected by the gender of the individuals. In the course of myocardial infarction and hypothyroidism, the level of aldehydic derivatives of protein oxidative modification is affected by age and physical activity, while the level of ketonic derivatives of protein oxidative modification is affected by the age of individuals.
... The thyroid gland exerts significant effects on various body tissues, but its impact on the cardiovascular system and kidney is particularly noteworthy. Abnormalities in thyroid gland morphology and dysfunction are associated with diabetes, while low T3 syndrome is linked to chronic kidney disease [34]. Hyperthyroid secretions can lead to increased cardiac preload, cardiac output, arterial stiffness, and systolic blood pressure. ...
... Ante la presentación con deterioro de la clase funcional, edemas y disnea, es claro que en el hipotiroidismo descompensado hay un efecto globalmente negativo sobre el funcionamiento cardiaco: disminuye la contractilidad y frecuencia cardiaca, aumenta la resistencia vascular periférica 14,18 . Sin embargo, rara vez progresa a insuficiencia cardiaca debido a la disminución de la demanda tisular de oxígeno y en general del metabolismo 12,19 . ...
... However, atrial fibrillation can also develop in horses treated with levothyroxine at high doses and in people, over-supplementation is associated with additional cardiovascular disorders including myocardial infarction and congestive heart failure. [69][70][71][72][73][74][75] If a horse has been on prolonged course of thyroid hormone supplementation for vague clinical complaints, gradual weaning over 2-4 weeks is recommended when therapy is to be discontinued. ...
Equine thyroid disorders pose a diagnostic challenge in clinical practice because of the effects of nonthyroidal factors on the hypothalamic–pituitary–thyroid axis, and the horse's ability to tolerate wide fluctuations in thyroid hormone concentrations and survive without a thyroid gland. While benign thyroid tumours are common in older horses, other disorders like primary hypothyroidism or hyperthyroidism in adult horses and congenital hypothyroidism in foals are rare. There is a common misunderstanding regarding hypothyroidism in adult horses, especially when associated with the clinical profile of obesity, lethargy, and poor performance observed in dogs and humans. Low blood thyroid hormone concentrations are often detected in horses as a secondary response to metabolic and disease states, including with the nonthyroidal illness syndrome; however, it is important to note that low thyroid hormone concentrations in these cases do not necessarily indicate hypothyroidism. Assessing equine thyroid function involves measuring thyroid hormone concentrations, including total and free fractions of thyroxine (T4) and triiodothyronine (T3); however, interpreting these results can be challenging due to the pulsatile secretion of thyroid hormones and the many factors that can affect their concentrations. Dynamic testing, such as the thyrotropin‐releasing hormone stimulation test, can help assess the thyroid gland response to stimulation. Although true hypothyroidism is extremely rare, thyroid hormone supplementation is commonly used in equine practice to help manage obesity and poor performance. This review focuses on thyroid gland pathophysiology in adult horses and foals, interpretation of blood thyroid hormone concentrations, and evaluation of horses with thyroid disorders. It also discusses the use of T4 supplementation in equine practice.
... The present study was a significant retrospective inquiry that targeted individuals with valvular heart disease who did not have any other metabolic disorders other coronary heart disease (17, 18). To minimize the effect on thyroid function, we also eliminated patients with thyroid illnesses (9,(19)(20)(21). In addition to examining thyroid function in patients with valvular heart disease, we also investigated how thyroid function related to other clinical indicators, such as baseline characteristics, indicators related to surgery and the intensive care unit, as well as outcome measures such as hospital stay and death. ...
... Despite this, TSH has remained a crucial guiding signal for thyroid therapeutic intervention trials. In individuals with valvular heart disease, TSH levels, and T3 and T4 levels may not align consistently, potentially due to abnormal conversion of T4 to T3 in peripheral tissues (20,25,26). Importantly, T3 or T4 levels may have greater clinical significance in these patients. ...
Background
Abnormal thyroid function is a metabolic disorder and can lead to several complications, including cardiovascular diseases. In this study, we aimed to examine the relationship between clinical traits and outcomes and the thyroid hormone level of euthyroid individuals with valvular heart disease (VHD).
Method
The thyroid function was evaluated in 526 euthyroid VHD patients and 155 healthy control people. As well as clinical indicators were collected and analyzed.
Results
No difference in TSH levels (p>0.05) was recorded; however, fT3, TT3, and TT4 levels were lower in the euthyroid VHD patients than in healthy control(4.3 vs 4.63; 1.37 vs 1.48; 97.7 vs 102.09, respectively, all p<0.05), while the fT4 level was higher (12.91 vs 12.35, p<0.05). Moreover, all showed a continuous trend with the change of NYHA grade which does not consist of the incidence of euthyroid sick syndrome(ESS). Further analysis showed that for every 10-fold increase in BNP, fT4 increases by 83%, fT3 decreases by 30%, and TT3 decreases by 12% after being adjusted for other influencing factors. Meanwhile, adjusted fT4 was correlated with multiple worse clinical indicators, which were influenced by age.
Conclusion
Thyroid hormones are widely regulated in VHD patients even with acceptable cardiac function, except for TSH level. And the adjusted fT4 is related to worse clinical indicators and outcomes which are only recorded in patients under 53 years old.
... A recent study suggests that thyroid hormones and thyroid stimulating hormone (TSH) are associated with the function of each organ system but also affect the body's growth and development, and it was found that the concentration of the thyroid hormones is owing to different age and sex [46]. Another study has found that thyroid hormones play a central regulatory role in the cardiovascular system and are considered a target for the treatment of heart failure [47]. At present, it is believed that thyroid hormone changes have a certain heritability, but most of the genetic possibilities cannot be explained; also, an analysis has found FT3-related genome-wide variations and new TSH-related loci [48]. ...
Previous studies showed a diurnal rhythm of uric acid. The mean serum uric acid value between 0800-0900 hours was higher than that observed between 1700-1800 hours. Oxidative stress is traditionally characterized as by imbalance among oxidant and antioxidant factors, occurs commonly in Mets. Antioxidant's system including enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and non-enzymatic substrates like ferritin, transferrin, and uric acid controls oxidative stress. Uric acid is an inactive metabolic result of purine catabolism, has been as of late implicated in various long term illness states, including arterial blood pressure, metabolic condition, diabetes, non-alcoholic fatty liver disorders, and chronic renal disorders. Raised uric acid may end up being one of the more significant remediable problematic factors for metabolic and cardiovascular disorders. A negative correlation is found between the levels of endogenous melatonin and UA. A positive correlation is found between the levels of cortisol and UA. Mets are characterized by hyperactivity of the HPA axis, which leads to "functional hypercortisolism.". Uric acid level is linearly correlated with FT3 and FT4, but not with TSH. In conclusion, catabolic hormones have positive correlation with serum uric acid while hormones which decrease basal metabolism have negative correlation with serum uric acid levels.
... Up to 30% of heart failure (HF) patients have some form of thyroid dysfunction, which may contribute to the onset and progression of HF [3]. One of the mechanisms for thyroid dysfunction is an impaired activity of deiodinases, decreasing the availability of T3 and leading to a state of functional hypothyroidism [3]. ...
... Up to 30% of heart failure (HF) patients have some form of thyroid dysfunction, which may contribute to the onset and progression of HF [3]. One of the mechanisms for thyroid dysfunction is an impaired activity of deiodinases, decreasing the availability of T3 and leading to a state of functional hypothyroidism [3]. Persistent neuroendocrine activation, poor nutritional status, hypoxia, and inflammatory responses are thought to be hallmarks of this impairment [4]. ...
... As previously stated, the ratio of FT3/FT4 has been suggested as an indirect index of deiodinase activity reflecting peripheral conversion of T4 into T3 [5]. Deiodinases' activity appears to be disturbed in several acute and chronic illnesses, including HF [3]. Although this decrease in T3 levels is seen as an adaptative response to reduce catabolic processes and energy expenditure, questions have been raised regarding the role of this mechanism in HF [4]. ...
Background:
Thyroid dysfunction is common in patients with heart failure (HF). Impaired conversion of free T4 (FT4) into free T3 (FT3) is thought to occur in these patients, decreasing the availability of FT3 and contributing to HF progression. In HF with preserved ejection fraction (HFpEF), it is not known whether changes in conversion of thyroid hormones (THs) are associated with clinical status and outcomes.
Objectives:
The objective of this study was to evaluate the association of FT3/FT4 ratio and TH with clinical, analytical, and echocardiographic parameters, as well as their prognostic impact in individuals with stable HFpEF.
Methods:
We evaluated 74 HFpEF participants of the NETDiamond cohort without known thyroid disease. We performed regression modeling to study the associations of TH and FT3/FT4 ratio with clinical, anthropometric, analytical, and echocardiographic parameters, and survival analysis to evaluate associations with the composite of diuretic intensification, urgent HF visit, HF hospitalization, or cardiovascular death over a median follow-up of 2.8 years.
Results:
The mean age was 73.7 years and 62% were men. The mean FT3/FT4 ratio was 2.63 (standard deviation: 0.43). Subjects with lower FT3/FT4 ratio were more likely to be obese and have atrial fibrillation. Lower FT3/FT4 ratio was associated with higher body fat (β = -5.60 kg per FT3/FT4 unit, p = 0.034), higher pulmonary arterial systolic pressure (PASP) (β = -10.26 mm Hg per FT3/FT4 unit, p = 0.002), and lower left ventricular ejection fraction (LVEF) (β = 3.60% per FT3/FT4 unit, p = 0.008). Lower FT3/FT4 ratio was associated with higher risk for the composite HF outcome (HR = 2.50, 95% CI: 1.04-5.88, per 1-unit decrease in FT3/FT4, p = 0.041).
Conclusions:
In patients with HFpEF, lower FT3/FT4 ratio was associated with higher body fat, higher PASP, and lower LVEF. Lower FT3/FT4 predicted a higher risk of diuretic intensification, urgent HF visits, HF hospitalization, or cardiovascular death. These findings suggest that decreased FT4 to FT3 conversion might be a mechanism associated with HFpEF progression.
... Esta asociación no ha sido bien estudiada. (3,5) En perspectiva, el tratamiento oportuno del hipertiroidismo como el seguimiento y todas las condiciones comórbidas que emporan esta condición de base, configuran un pilar fundamental en el desarrollo de la falla cardíaca crónica para el pronóstico y el tratamiento. Sin embargo, la falta de evidencia científica concluyente hace necesaria la implementación y desarrollo de nuevas evidencias guiadas en diferentes investigaciones, que tipifiquen algunos aspectos con relación a esta asociación fisiopatológica que permita esclarecer un mejor pronóstico y una calidad de vida al paciente, lo cual conlleva a una disminución en la morbimortalidad de la falla cardíaca, una entidad con alta prevalencia global. ...
... Жінки із ЗХС вище за 7 ммоль/л мали приблизно в 7 разів вищий ризик роз- Оригінальні дослідження / Original Researches витку гіпотиреозу. Причому такого зв'язку не було виявлено у чоловіків, і цю розбіжність не можна пояснити різницею в прийомі гіполіпідемічних препаратів [30]. З приводу коморбідних захворювань, які спостерігаються у пацієнтів з гіпотиреозом, наше дослідження підтверджує попередні спостереження про те, що пацієнти з гіпотиреозом мають значно більшу поширеність супутніх захворювань, пов'язаних із високим серцево-судинним ризиком, як-от: цукровий діабет, хронічна хвороба нирок, значні атеросклеротичні ураження артерій, ФП. ...
... З приводу коморбідних захворювань, які спостерігаються у пацієнтів з гіпотиреозом, наше дослідження підтверджує попередні спостереження про те, що пацієнти з гіпотиреозом мають значно більшу поширеність супутніх захворювань, пов'язаних із високим серцево-судинним ризиком, як-от: цукровий діабет, хронічна хвороба нирок, значні атеросклеротичні ураження артерій, ФП. Це дослідження підтверджує попередні РКД, які продемонстрували значний спектр патофізіологічних ефектів гормонів ЩЗ на серцево-судинну систему, з чого можемо дійти висновку, що гіпотиреоз сам по собі є не лише маркером ризику виникнення великих серцево-судинних подій, а й потребує адекватного лікування для редукції серцево-судинних ускладнень та смертності [30]. ...
Background. Thyroid hormones play a fundamental role in the homeostasis of the cardiovascular system. Cardiovascular diseases are among the most common diseases worldwide, causing a significant percentage of mortality, hospitalizations, and disability. The purpose of the study is to evaluate the impact of hypothyroidism on the course of atherosclerotic lesions of coronary arteries and major cardiovascular events in patients with heart failure with reduced left ventricular ejection fraction after myocardial revascularization using percutaneous coronary intervention (PCI). Materials and methods. This prospective observational one-center study included 103 patients with ischemic cardiomyopathy, heart failure with reduced left ventricular ejection fraction, with and without hypothyroidism who underwent PCI. The result of revascularization was evaluated within 2 years. Inclusion criteria: age over 18 years, coronary artery disease, left ventricular ejection fraction less than 40 %. Results. Patients with hypothyroidism had a worse lipid profile and, as expected, a higher baseline thyroid-stimulating hormone (TSH). According to echocardiography, patients with hypothyroidism had thickening of the left ventricular myocardium walls, which is indicated by a probable increase in the dimensions of the left ventricular posterior wall (11.40 ± 0.98 mm; p
