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Thyroid hormone and cardiac contractility

  • Irwin Klein
    Correspondence
    Address for reprints: Irwin Klein, MD, North Shore University Hospital, 300 Community Drive, Manhasset, New York 11030, USA.
    Affiliations
    From the Division of Endocrinology, North Shore University Hospital, Manhasset, New YorkNew York University School of Medicine, New York, New York, USA, USA
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      It has long been recognized that thyroid disease states exert profound effects on the heart and cardiovascular system.
      • Graves R.J.
      Newly observed affectation of the thyroid gland in females.
      These include enhanced cardiac contractility, increased cardiac output, and decreased systemic vascular resistance of hyperthyroidism, and impaired cardiac contractility, decreased cardiac output, and increased systemic vascular resistance, which has been uniformly observed with overt hypothyroidism.
      • Klein I.
      • Ojamaa K.
      Mechanisms of disease thyroid hormone and the cardiovascular system.
      Just as reproducible as the hemodynamic changes that accompany thyroid disease are the reports that treatment with restoration of a euthyroid (normal T4, T3, thyroid stimulating hormone [TSH]) state leads to normalization of essentially every cardiovascular parameter.
      • Mintz G.
      • Pizzarello R.
      • Klein I.
      Enhanced left ventricular diastolic function in hyperthyroidism noninvasive assessment and response to treatment.
      Although thyroid disease in all its forms affects approximately 12 million adults in the American population, the prevalence of hypothyroidism is substantially greater than that of thyrotoxicosis.

      Levey GS, Klein I. Disorders of the thyroid. In: Stein J, ed. Internal Medicine. 5th ed. Boston, MA: Little Brown & Co., 1998:1323–1349

      Advancing age produces an increase in the incidence of hypothyroidism, and after age 60, disease prevalence may be as high as 12% to 15%.
      • Canaris G.J.
      • Manowitz N.R.
      • Mayor G.M.
      • Ridgway E.C.
      The Colorado thyroid prevalence study.
      Most patients, however, have relatively mild disease. This has been characterized as “subclinical hypothyroidism,” based upon the fact that although the TSH is elevated above the normal range (0.3 to 3.5 μIU/ml), it is <10 μIU/ml; serum total T4 and total T3 levels usually fall within the normal range. In these patients, the classic signs and symptoms of hypothyrodism including fatigue, weight gain, constipation, and hypercholesterolemia; hypertension and bradycardia are absent or only minimally abnormal. Thus, the decision to initiate thyroid hormone replacement in this setting is controversial because studies demonstrating the benefit of such treatment remain in conflict with other studies showing no improvement.
      • Biondi B.
      • Palmieri E.
      • Lombardi G.
      • Fazio S.
      Effects of subclinical thyroid dysfunction on the heart.
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      References

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        Newly observed affectation of the thyroid gland in females.
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        Enhanced left ventricular diastolic function in hyperthyroidism.
        J Clin Endocrinol Metab. 1991; 73: 146-150
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