Central European Journal of Medicine

, Volume 9, Issue 1, pp 10–14 | Cite as

‘Low — T3 syndrome’ among patients with acute myocardial infarction

  • Edita Jankauskienė
  • Jolanta-Justina Vaškelytė
  • Eglė Rumbinaitė
Review Article



Recent clinical studies have found that cardiovascular incidents are sufficient triggers to affect HPA hypothalamic-pituitarythyroid axis and cause a decrease in the serum levels of triiodothyronine (T3). This phenomenon is so called ‘Low — triiodothyronine (T3) syndrome’ and is related to changes in heart remodeling. However, the pathophysiology of Low—T3 syndrome remains unclear. The present systemic literature review was designed to organize the latest scientific papers and is seeking to draw evidence-based conclusions regarding clinical aspects of the topic.


Accessible scientific databases were analyzed using key words to obtain scientific papers regarding the field of interest. Research findings were assessed and compared between studies in order to find out clinical impact of thyroid hormone and heart function following acute myocardial injury.


Different studies indicate that the presence of Low-T3 syndrome after myocardial infarction is a strong predicting factor of patient morbidity and mortality. Some researchers believe that the decrease in T3 concentrations might be a compensatory reaction of the body in order to suppress cellular metabolism during tissue damage. On the other hand, a limited number of recent experimental and clinical investigations have shown positive response to treatment with thyroid hormone.


Deeper analysis is needed to understand the pathophysiology of Low-T3 syndrome and possibilities of its use for treatment.


Low — T3 syndrome Triiodothyronine Myocardial infarction Heart remodeling 


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  1. [1]
    Kalofoutis C., Mourouzis I., Galanopoulos G., Dimopoulos A., Perimenis P., Spangu D., et al., Thyroid hormone can favorably remodel the diabetic myocardium after acute myocardial infarction, Mol Cell Biochem., 2010, 345, 161–169PubMedCrossRefGoogle Scholar
  2. [2]
    Cohn J.N., Ferrari R., Sharpe N., Cardiac remodeling-concepts and clinical implications: a consensus paper from international forum on cardiac remodeling, J Am Coll Cardiol., 2000, 35, 569–582PubMedCrossRefGoogle Scholar
  3. [3]
    Roberts C.S., Maclean D., Maroko P., Kloner R.A., Early and late remodeling of the left ventricle after acute myocardial infarction, Am J Cardiol., 1984, 54, 3, 407–410PubMedCrossRefGoogle Scholar
  4. [4]
    Pirolo J.S., Hutchins G.M., Moore G.W., Infarct expansion: pathologic anglysis of 204 patients with a single myocardial infarct, J Am Coll Cardiol., 1986, 7(2), 349–354PubMedCrossRefGoogle Scholar
  5. [5]
    Pfeffer M.A., Braunwald E., Ventricular remodeling after myocardial infarction, Experimental observations and clinical implications, Circ J., 1990, 81(4), 1161–1172CrossRefGoogle Scholar
  6. [6]
    Carrabba N., Parodi G., Valenti R., Migliorini A., Bellandi B., Antoniucci D., Prognostic value of reverse left ventricular remodeling after primary angioplasty for STEMI, Atherosclerosis., 2012, 222, 123–128PubMedCrossRefGoogle Scholar
  7. [7]
    Mitchell G.F., Lamas G.A., Vaughan D.E., Pfefer M.A., Left ventricular remodeling in the year after first anterior myocardial infarction: a quantitative analysis of contractile segment lengths and ventricular shape, J Am Coll Cardiol., 1992, 19, 1136–1144PubMedCrossRefGoogle Scholar
  8. [8]
    Rumberger J.A., Behrenbeck T., Breen J.R., Reed J.E., Gersh B.J., Nonparallel changes in global left ventricular chamber volume and muscle mass during the first year after transmural myocardial infarction in humans, J Am Coll Cardiol., 1993, 21, 673–682PubMedCrossRefGoogle Scholar
  9. [9]
    Springeling T., Kirschbaum S.W., Rossi A., Baks T., Karamermer Y., Schulz C., et al, Late cardiac remodeling after primary percutaneous coronary intervention-five-year cardiac magnetic resonance imaging follow-up, Circ J., 2012, 77(1), 81–88PubMedCrossRefGoogle Scholar
  10. [10]
    Galiuto L., Gabrielli F.A., Lanza G.A., Porfidia A., Paraggio L., Barcheta S., et al, Influence of left ventricular hypertrophy on microvascular dysfunction and left ventricular remodelling after acute myocardial infarction,. European Journal of Echocardiography., 2010, 11, 677–682PubMedCrossRefGoogle Scholar
  11. [11]
    Galli E., Pingitore A., Iervasi G., The role of thyroid in the pathophysiology of heart failure: clinical evidence, Heart Fail Rev., 2010, 155–169Google Scholar
  12. [12]
    Coceani M., Iervasi G., Pingitore A., Carpeggiani C., L’Abbate A., Thyroid hormone and coronary artery disease: from clinical correlations to prognostic implications, Clin Cardiol., 2009, 32(7), 380–385PubMedCrossRefGoogle Scholar
  13. [13]
    Coceani M., Heart disease in patients with thyroid dysfunction: hyperthyroidism, hypothyroidism and beyonm, Anadolu Kardiyol Derg., 2013, 13(1), 62–6PubMedGoogle Scholar
  14. [14]
    Olivares E.L, Carvalho D.P., Thyroid hormone metabolism in heart failure: iodothyronine deiodinases in focus, Curr Opin Endocrinol Diabetes Obes., 2010, 17, 414–417PubMedCrossRefGoogle Scholar
  15. [15]
    De Groot L.J., Non-thyroidal ilness sindrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies, Crit Care Clin., 2006, 22, 57–86PubMedCrossRefGoogle Scholar
  16. [16]
    Bianco A.C, Larsen P.R., Cellular and structural biology of the deiodinases, Thyroid., 2005, 15, 777–786PubMedCrossRefGoogle Scholar
  17. [17]
    Iervasi G., Pingitore A., Landi P., Raciti M., Ripoli A., Scarlattini M., et al., Low-T3 syndrome a strong prognostic predictor of death in patients with heart disease, Circulation., 2003, 107, 708–713PubMedCrossRefGoogle Scholar
  18. [18]
    Gereben B., Zavacki A.M., Ribich S., Kim B.W., Huang S.A., Simonides W.S., et al, Cellular and molecular basis of deiodinase-regulated thyroid hormone signaling, Endocr Rev., 2008, 29, 898–938PubMedCrossRefGoogle Scholar
  19. [19]
    Simonides W.S., Cardiac thyroid-hormone deiodinative pathways in ventricular hypertrophy and heart failure, In: Iervasi G, Pingitore A. (Eds.), Thyroid and heart failure from pathophysiology to clinics., Springer-Verlag Italia., 2009, 67–77CrossRefGoogle Scholar
  20. [20]
    Olivares E.L., Marassi M.P., Fortunato R.S., Da Silva A.C., Costa-e-Sousa R.H., Araujo I.G., et al., Thyroid function disturbance and type 3 iodothyronine deiodinase induction after myocardial infarction in rats a time course stud,. Endocrinology., 2007, 148, 4786–4792PubMedCrossRefGoogle Scholar
  21. [21]
    Wassen F.W., Schiel A.E., Kuiper G.G., Kaptein E., Bakker O., Visser T.J., et al, Induction of thyroid hormone-degrading deiodinase in cardiac hypertrophy and failure, Endocrinology., 2002, 143, 2812–2815PubMedGoogle Scholar
  22. [22]
    Pol C., Zuidwijk M., Deel E., Muller A., Visser T.J., Duncker D., et al, Left ventricular myocardial infarction in mice induces sustained cardiac deiodinase type III activity, XXVIII European Section Meeting of the International Society for Heart Research, Medimond International Proceedings, Bologna, Italy., 2008, 57–60Google Scholar
  23. [23]
    lymvaios I., Mourouzis I., Cokkinos D.V., Dimopoulos M.A., Toumanidis S.T., Pantos C., Thyroid hormone and recovery of cardiac function in patients with acute myocardial infarction: a strong association, European Journal of Endocrinology., 2011, 165, 1–9CrossRefGoogle Scholar
  24. [24]
    Cini G., Carpi A., Mechanink J., Cini L., Camici M., Galleta F., et al., Thyroid hormones and the cardiovascular system: pathophysiology and interventions, Biomedicine and Pharmacotherapy., 2009, 63, 742–753PubMedCrossRefGoogle Scholar
  25. [25]
    Pingitore A., Iervasi G., Triiodothyronine (T3) effects on cardiovascular system in patients with heart failure, Recent Patents Cardiovasc Drug Discov., 2008, 3, 19–27CrossRefGoogle Scholar
  26. [26]
    Friberg L., Werner S., Eggertsen G., Ahnve S., Rapid down-regulation of thyroid hormones in acute myocardial infarction: is it cardioprotective in patients with angina? Arch Intern Med. 2002; 162, 1388–1394PubMedCrossRefGoogle Scholar
  27. [27]
    Ezekowitz J.A., Kaul P., Bakal JA., Armstrong P.W., Welsh R.C., Mcalister F.A., Declining in-hospital mortality and increasing heart failure incidente in elderly patients with first myocardial infarction, J Am Coll Cardiol., 2009, 53, 13–20PubMedCrossRefGoogle Scholar
  28. [28]
    Gajarsa J.J., Kloner R.A., Left ventricular remodeling in the post-infarction heart: a review of cellular, molecular mechanisms, and therapeutic modalities, Heart Fail Rev., 2011, 16, 13–21PubMedCrossRefGoogle Scholar
  29. [29]
    Pantos C., Mourouzis I., Xinaris C., Papadopoulou-Daifoti Z., Cokkinos D, Thyroid hormone and „cardiac metamorphosis”": potential therapeutic implications, Pharmacology and Therapeutics., 2008, 118, 277–294PubMedCrossRefGoogle Scholar
  30. [30]
    Pantos C., Mourouzis I., Saranteas T., Clave G., Ligeret H., Noack-Fraissignes P., et al., Thyroid hormone improves postischemic recovery of function while limiting apoptosis: a new therapeutic approach to support hemodynamics in the setting of ischemia-reperfusion? Basic Research in Cardiology., 2009, 104, 69–77PubMedCrossRefGoogle Scholar
  31. [31]
    Pantos C., Mourouzis I., Cokkinos DV., New insights into the role of thyroid hormone in cardiac remodeling: time to reconsider? Heart Fail Rev., 2011, 16, 79–96PubMedCrossRefGoogle Scholar
  32. [32]
    Pantos C., Mourouzis I., Xinaris C., Kokkinos A.D., Markais A., Dimopoulos A., et al., Time-dependent changes in the expression of thyroid hormone receptor α1 in the myocardium after acute myocardial infarction: posible implications in cardiac remodeling, Eur J Endocrinol., 2007, 156, 415–424PubMedCrossRefGoogle Scholar
  33. [33]
    Pantos C., Mourouzis I., Cokkinos V., Thyroid hormone and ischemic myocardium, In: Iervasi G, Pingitore A. (Eds.), Thyroid and heart failure from pathophysiology to clinics, Springer-Verlag Italia., 2009, 131–13CrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Edita Jankauskienė
    • 1
  • Jolanta-Justina Vaškelytė
    • 1
  • Eglė Rumbinaitė
    • 1
  1. 1.Department of Cardiology at Lithuanian University of Health Sciences HospitalKaunas clinicsKaunasLithuania

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