Abstract
Background and Objectives: Thyroid hormones (TH) affect cardiac function through effects on cardiac contractility and systemic vascular resistance. While TH replacement for patients with hypothyroidism might be necessary for restoration of cardiac output after an acute myocardial infarction (AMI), it could theoretically lead to excessively rapid restoration of the metabolic rate. The appropriate management of hypothyroidism in patients with AMI is unknown. We describe the practice patterns in the management of hypothyroidism in the setting of AMI as well as patients’ clinical outcomes. Material and Methods: Retrospective study of patients that were admitted to a tertiary care hospital with AMI and newly diagnosed or uncontrolled hypothyroidism (TSH ≥ 10 mIU/L) between 2011–2018. Eligible patients were identified using diagnosis codes for AMI and laboratory values, followed by medical record review. We categorized patients according to treatment status with TH and by degree of hypothyroidism. Clinical outcomes included: 30-day mortality/readmission, bleeding, stroke, arrhythmia, sudden cardiac death, and new or worsening heart failure. Summary statistics and group comparisons are presented. Results: Sixty-four patients were included, their median age was 64 years and 61% (n = 39) were women. Most of the patients (59%) had a documented history of hypothyroidism. Of these, all were restarted on levothyroxine (LT4) during the index admission when compared to patients without a history of hypothyroidism, of which 54% received LT4 treatment (p = 0.001). The median TSH in those treated with LT4 was higher (25 mIU/L) when compared to those who were not (12 mIU/L), (p = 0.007). Patients who received intravenous LT4 had higher TSH levels and other variables suggesting worse clinical presentation, but these differences were not statistically significant. No statistically significant differences were noted on clinical outcomes according to LT4 treatment status. Conclusion: A history of hypothyroidism and the degree of TSH elevation seem to guide the management of hypothyroidism in patients with AMI. The clinical effect of correcting hypothyroidism in this setting requires further evaluation.
Highlights
Thyroid hormones (TH) affect the function of the cardiovascular system by modulating genomic and non-genomic pathways in cardiac myocytes, vascular smooth muscle, and endothelial cells, and by their effects on lipid metabolism and other inflammatory pathways that are associated withMedicina 2020, 56, 214; doi:10.3390/medicina56050214 www.mdpi.com/journal/medicinaMedicina 2020, 56, 214 cardiovascular disease [1,2]
This study was approved by the Institutional Review Board (IRB) of University of Florida (UF) under IRB201900380 approved on 11 February 2019 as exempt, because it posed a minimal risk to participants
An initial cohort of 115 patients admitted with a diagnosis of acute myocardial infarction (AMI) and found to have a thyroid stimulating hormone (TSH)
Summary
Thyroid hormones (TH) affect the function of the cardiovascular system by modulating genomic and non-genomic pathways in cardiac myocytes, vascular smooth muscle, and endothelial cells, and by their effects on lipid metabolism and other inflammatory pathways that are associated withMedicina 2020, 56, 214; doi:10.3390/medicina56050214 www.mdpi.com/journal/medicinaMedicina 2020, 56, 214 cardiovascular disease [1,2]. Thyroid hormones (TH) affect the function of the cardiovascular system by modulating genomic and non-genomic pathways in cardiac myocytes, vascular smooth muscle, and endothelial cells, and by their effects on lipid metabolism and other inflammatory pathways that are associated with. The proposed negative effects on the cardiovascular system include increased systemic vascular resistance and decreased cardiac output, heart rate, and myocardial contractility [1,2,3]. Low triiodothyronine (T3) has been identified as a prognostic factor for patients with acute myocardial infarction (AMI) associated with increased biomarkers of cardiac injury, decreased left ventricular function, and increased mortality [6,7]. Thyroid hormones (TH) affect cardiac function through effects on cardiac contractility and systemic vascular resistance.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
