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Thyroid hormone and heart failure

Abstract

Thyroid hormone metabolic disarray has been identified as a risk factor for the progression of heart disease and the development of heart failure (HF). Both hyper-and hypothyroidism have been associated with a failing myocardium. Poor cardiac contractility and low cardiac output due to hyperthyroidism is a rare occurrence and is mostly seen in patients with preexisting heart disease. Referred to as a "rate related" phenomenon, hyperthyroid-induced sustained sinus tachycardia or atrial fibrillation may further reduce ventricular contractility. Increasingly, the hypothyroid state, and in particular a low triiodothyronine level, has been associated with a reduced cardiac performance and poor prognosis in HF, even in the presence of normal thyroid-stimulating hormone levels. Low thyroid hormone levels alter cardiac gene expression and increase systemic vascular resistance, both resulting in a reduction of cardiac contractility and cardiac output. This review summarizes current data on thyroid dysfunction and HF as well as the emerging implications of the "low triiodothyronine state."

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References and Recommended Reading

  1. 1.

    Danzi S, Klein I: Thyroid hormone and the cardiovascular system. Minerva Endocrinol 2004, 29:139–150.

    PubMed  CAS  Google Scholar 

  2. 2.

    Iervasi G, Pingitore A, Landi P, et al.: Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation 2003, 107:708–713.

    PubMed  Article  Google Scholar 

  3. 3.

    Hamilton MA, Stevenson LW: Thyroid hormone abnormalities in heart failure: possibilities for therapy. Thyroid 1996, 6:527–529.

    PubMed  CAS  Google Scholar 

  4. 4.

    Levey GS Klein I: Disorders of the Thyroid, edn 5. St. Louis: Mosby-Year Book, Inc.; 1998.

    Google Scholar 

  5. 5.

    Ascheim DD, Hryniewicz K: Thyroid hormone metabolism in patients with congestive heart failure: the low triiodothyronine state. Thyroid 2002, 12:511–515.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Pachucki J, Hopkins J, Peeters R, et al.: Type 2 iodothyronin deiodinase transgene expression in the mouse heart causes cardiac-specific thyrotoxicosis. Endocrinology 2001, 142:13–20.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Klein I, Ojamaa K: Thyroid hormone and the cardiovascular system. N Engl J Med 2001, 344:501–509.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Ojamaa K, Klemperer JD, Klein I: Acute effects of thyroid hormone on vascular smooth muscle. Thyroid 1996, 6:505–512.

    PubMed  CAS  Google Scholar 

  9. 9.

    Resnick LM, Laragh JH: PLasma renin activity in syndromes of thyroid hormone excess and deficiency. Life Sci 1982, 30:585–586.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Klein I: Thyroid hormone and the cardiovascular system. Am J Med 1990, 88:631–637.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Riaz K, Forker AD, Isley WL, et al.: Hyperthyroidism: a "curable" cause of congestive heart failure—three case reports and a review of the literature. Congest Heart Fail 2003, 9:40–46. This paper reviews hyperthyroidism as a cause for CHF and presents three case reports of CHF due to systolic LVD secondary to hyperthyroidism, which showed considerable improvement in the left ventricular function once the hyperthyroidism was treated.

    PubMed  Google Scholar 

  12. 12.

    Weinbrenner C, Gerbert B, Strasser RH: Thyroid hormone and the cardiovascular system. [in German]. Dtsch Med Wochenschr 2005, 130:2215–2219.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Klein I, Ojamaa K: Thyrotoxicosis and the heart. Endocrinol Metab Clin North Am 1998, 27:51–62.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Pereira N, Parisi A, Dec GW, et al.: Myocardial stunning in hyperthyroidism. Clin Cardiol 2000, 23:298–300.

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Marti V, Ballester M, Obrador D, et al.: Active myocardial damage in hyperthyroidism. A concurrent mechanism of heart failure reversed by treatment. Eur Heart J 1995, 16:1014–1016.

    PubMed  CAS  Google Scholar 

  16. 16.

    Klein I, Becker DV, Levey GS: Treatment of hyperthyroid disease. Ann Intern Med 1994, 121:281–288.

    PubMed  CAS  Google Scholar 

  17. 17.

    Vickers P, Garg KM, Arya R, et al.: The role of selective beta 1-blocker in the preoperative preparation of thyrotoxicosis: a comparative study with propranolol. Int Surg 1990, 75:179–183.

    PubMed  CAS  Google Scholar 

  18. 18.

    Bengel FM, Nekolla SG, Ibrahim T, et al.: Effect of thyroid hormones on cardiac function, geometry, and oxidative metabolism assessed noninvasively by positron emission tomography and magnetic resonance imaging. J Clin Endocrinol Metab 2000, 85:1822–1827.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Tang YD, Kuzman JA, Said S, et al.: Low thyroid function leads to cardiac atrophy with chamber dilatation, impaired myocardial blood flow, loss of arterioles, and severe systolic dysfunction. Circulation 2005, 112:3122–3130.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Rodondi N, Newman AB, Vittinghoff E, et al.: Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 2005, 165:2460–2466. A study of 2730 men and women demonstrated that subclinical hypothyroidism was associated with a higher incidence and recurrence of CHF among patients with TSH levels of 7.0 mIU/L or greater compared with euthyroid participants but was not related to an increased risk for total mortality.

    PubMed  Article  Google Scholar 

  21. 21.

    Surks MI, Ocampo E: Subclinical thyroid disease. Am J Med 1996, 100:217–223.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Ripoli A, Pingitore A, Favilli B, et al.: Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study. J Am Coll Cardiol 2005, 45:439–445.

    PubMed  Article  Google Scholar 

  23. 23.

    Hamilton MA, Stevenson LW, Luu M, Walden JA: Altered thyroid hormone metabolism in advanced heart failure. J Am Coll Cardiol 1990, 16:91–95.

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Opasich C, Pacini F, Ambrosino N, et al.: Sick euthyroid syndrome in patients with moderate-to-severe chronic heart failure. Eur Heart J 1996, 17:1860–1866.

    PubMed  CAS  Google Scholar 

  25. 25.

    Friberg L, Werner S, Eggertsen G, Ahnve S: Rapid downregulation of thyroid hormones in acute myocardial infarction: is it cardioprotective in patients with angina? Arch Intern Med 2002, 162:1388–1394.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Holland FW 2nd, Brown PS Jr, Weintraub BD, Clark RE: Cardiopulmonary bypass and thyroid function: a "euthyroid sick syndrome". Ann Thorac Surg 1991, 52:46–50.

    PubMed  Article  Google Scholar 

  27. 27.

    Nomura S, Pittman CS, Chambers JB Jr, et al.: Reduced peripheral conversion of thyroxine to triiodothyronine in patients with hepatic cirrhosis. J Clin Invest 1975, 56:643–652.

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    van Doorn J, van der Heide D, Roelfsema F: The influence of partial food deprivation on the quantity and source of triiodothyronine in several tissues of athyreotic thyroxinemaintained rats. Endocrinology 1984, 115:705–711.

    PubMed  Article  Google Scholar 

  29. 29.

    Harjai KJ, Licata AA: Effects of amiodarone on thyroid function. Ann Intern Med 1997, 126:63–73.

    PubMed  CAS  Google Scholar 

  30. 30.

    Kinugawa K, Minobe WA, Wood WM, et al.: Signaling pathways responsible for fetal gene induction in the failing human heart: evidence for altered thyroid hormone receptor gene expression. Circulation 2001, 103:1089–1094.

    PubMed  CAS  Google Scholar 

  31. 31.

    Forini F, Paolicchi A, Pizzorusso T, et al.: 3,5,3’-triiodothyronine deprivation affects phenotype and intracellular [Ca2+]i of human cardiomyocytes in culture. Cardiovasc Res 2001, 51:322–330.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Katzeff HL, Powell SR, Ojamaa K: Alterations in cardiac contractility and gene expression during low-T3 syndrome: prevention with T3. Am J Physiol 1997, 273:E951-E956.

    PubMed  CAS  Google Scholar 

  33. 33.

    Pingitore A, Landi P, Taddei MC, et al.: Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med 2005, 118:132–136. This prospective study analyzed 281 patients with postischemic or nonischemic dilated cardiomyopathy and demonstrated that low T3 levels were an independent predictor of all-cause and cardiac mortality in the chronic HF cohort.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Hamilton MA, Stevenson LW, Fonarow GC, et al.: Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure. Am J Cardiol 1998, 81:443–447.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Moruzzi P, Doria E, Agostoni PG: Medium-term effectiveness of L-thyroxine treatment in idiopathic dilated cardiomyopathy. Am J Med 1996, 101:461–467.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Moruzzi P, Doria E, Agostoni PG, et al.: Usefulness of L-thyroxine to improve cardiac and exercise performance in idiopathic dilated cardiomyopathy. Am J Cardiol 1994, 73:374–378.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Klemperer JD, Klein IL, Ojamaa K, et al.: Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations. Ann Thorac Surg 1996, 61:1323–1327; discussion 1328–1329.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Morkin E, Ladenson P, Goldman S, Adamson C: Thyroid hormone analogs for treatment of hypercholesterolemia and heart failure: past, present and future prospects. J Mol Cell Cardiol 2004, 37:1137–1146.

    PubMed  CAS  Google Scholar 

  39. 39.

    Wiersinga W: Amiodarone and Thyroid. Berlin: Springer Verlag; 1997:225–287.

    Google Scholar 

  40. 40.

    Martino E, Safran M, Aghini-Lombardi F, et al.: Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann Intern Med 1984, 101:28–34.

    PubMed  CAS  Google Scholar 

  41. 41.

    Polikar R, Burger AG, Scherrer U, Nicod P: The thyroid and the heart. Circulation 1993, 87:1435–1441.

    PubMed  CAS  Google Scholar 

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Correspondence to Deborah Davis Ascheim MD.

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Schmidt-Ott, U.M., Ascheim, D.D. Thyroid hormone and heart failure. Curr Heart Fail Rep 3, 114–119 (2006). https://doi.org/10.1007/s11897-006-0010-1

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Keywords

  • Thyroid Hormone
  • Amiodarone
  • Hyperthyroidism
  • Subclinical Hypothyroidism
  • Overt Hypothyroidism