Cardiac Metabolic Changes in Altered Thyroid States

  • Michael A. PortmanEmail author


Thyroid hormones regulate multiple metabolic processes in myocardium that can impact cardiac function and adaptation. These processes are regulated directly by triiodothyronine (T3) or through transcription regulated mainly through nuclear receptors. Early work suggested that metabolism changes secondary to cardiac functional changes and myocyte remodeling. Newer concepts include metabolism as a factor that causes or at least exacerbates heart failure. Energy starvation contributes to myocardial dysfunction and adverse remodeling. Systemic thyroid hormone homeostasis is disrupted during heart failure and during mechanical circulatory support, thereby interfering with normal substrate oxidation and oxidative phosphorylation. Clinical studies have shown that thyroid hormone supplementation in these altered states improves cardiac function. Studies in animal models emulating clinical scenarios with disrupted thyroid homeostasis, particularly following ischemia-reperfusion, demonstrate that thyroid supplementation promotes flux through pyruvate dehydrogenase (PDH) in the heart along with preservation of high-energy phosphate reserves and contractile function.


Cardiac metabolism Pyruvate Lactate Substrate oxidation Adenine nucleotide translocator 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of Washington and Seattle Children’s Research InstituteSeattleUSA

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