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Mechanism of Action of Thyroid Hormone on the Cardiac Vascular System

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Thyroid and Heart Failure

Abstract

The influences of thyroid hormone action on cardiovascular function present a complex mix of beneficial adaptive and maladaptive effects. Increased thyroid hormone action mediates an increased speed of diastolic relaxation and an increased speed and force of systolic contraction. Beneficial thyroid hormone effects are caused in part by alterations in calcium handling, which are based on changes in the expression of important proteins involved in this process. These include increases in the level of calcium ATPase of the sarcoplasmic reticulum (SERCa2) and decreases in phospholamban levels. Increased thyroid hormone action also has marked electrophysiological effects resulting in increased heart rate and an increased propensity for cardiac arrhythmias, especially atrial fibrillation. In addition, thyroid hormone exerts marked effects, on the vascular system, decreasing arterial resistance and thus diminishing cardiac afterload. Hyperthyroidism of some duration results in cardiac hypertrophy. Recently, thyroid hormone analogues have been developed that target the thyroid hormone receptor-β in the liver, mediating the lowering of lipid levels without significant other cardiac effects, especially without an increase in heart rate or cardiac arrhythmias. Severe heart failure of different causes can lead to the nonthyroidal illness syndrome, resulting in decreased thyroid hormone levels. Studies in human beings and animal models have also shown that the levels of thyroid hormone receptor-α and-β are decreased in the failing heart. Alternatively, the syndrome may lead to a cardiac status compatible with a “hypothyroid heart.” It is currently unclear whether the nonthyroidal illness syndrome presents an adaptive or a maladaptive phenomenon whit respect to cardiac function. In some clinical trials, administration of thyroid hormone to patients with heart-failure-induced nonthyroidal illness syndromes has had beneficial effects; however, other trials did not show improvements in cardiac function.

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Authors and Affiliations

  1. Department of Medicine, University of California, San Diego, CA, USA

    Wolfgang H. Dillmann MD

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  1. Wolfgang H. Dillmann MD
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Editors and Affiliations

  1. C.N.R. Clinical Physiology Institute, S. Cataldo Research Campus, Pisa, Italy

    Giorgio Iervasi  & Alessandro Pingitore  & 

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Dillmann, W.H. (2009). Mechanism of Action of Thyroid Hormone on the Cardiac Vascular System. In: Iervasi, G., Pingitore, A. (eds) Thyroid and Heart Failure. Springer, Milano. https://doi.org/10.1007/978-88-470-1143-4_5

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  • DOI: https://doi.org/10.1007/978-88-470-1143-4_5

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