Abstract
Background and aims: Serum thyroid hormonal changes can occur in acute or chronic non-thyroidal systemic illness including acute coronary syndrome in otherwise euthyroid individuals. In this study we aimed to assess thyroid hormonal profile in patients presenting with acute coronary syndromes (ACS) and compare between ST segment elevated myocardial infarction and unstable angina/Non ST segment elevated myocardial infarction.Methods: A hospital based, retrospective, observational comparative study was designed. Data of all patients with acute coronary syndrome presenting to hospital were collected from July 2015 through June 2017 in a pre-structured proforma and analyzed.Results: A total of 200 ACS patients between 23 years to 88 years with mean age of 61.33 ± 12.30 years were studied. One hundred and twenty seven (63.5%) were males. Among them 116 (58%) was ST segment elevated myocardial infarction (STEMI) patients while 84 (42%) were unstable angina/ non-ST elevated myocardial infarction (UA/ NSTEMI) patients. Total 47 (23.5%) patients had abnormal TFT of which 28(59.5%) had Euthyroid Sick Syndrome, 12(25.5%) had subclinical hypothyroidism, 5(10.6%) had subclinical hyperthyroidism and 2(4.25%) had low fT4 with normal fT3 and normal TSH. There was significant difference in TFT in patients with STEMI and UA/NSTEMI (P=0.006).There were higher rates of heart failure (p= 0.001 & 0.003 in STEMI & UA/NSTEMI respectively), longer length of hospital stay (3+0.17 days) and high mortality (more than 4 fold) in all types of ACS patients with abnormal TFT than ACS patients with normal TFT.Conclusion: There is higher prevalence of abnormal thyroid hormonal findings in ACS causing significant morbidity and mortality.
Highlights
Alteration in the level of serum thyroid hormone profile has been described in several non-thyroidal systemic illnesses including acute heart diseases in otherwise euthyriod patients
This study aims to study the thyroid hormone profile in patients of acute coronary syndromes (ACS) and to compare it in between segment elevated myocardial infarction (STEMI) and UA/NSTEMI groups
This is a hospital based, cross-sectional, comparative, observational study done from July 2015 to June 2017 in the department of cardiology of Manipal Teaching hospital, Nepal. 200 consecutive cases of acute coronary syndromes were taken for the study
Summary
Alteration in the level of serum thyroid hormone profile has been described in several non-thyroidal systemic illnesses including acute heart diseases in otherwise euthyriod patients. This condition has been termed as “Euthyroid Sick Syndrome” and is characterized by decreased serum T3 and /or free T3, increased serum reverse T3 (rT3), plus normal serum TSH, T4, and free T4 levels[1 ].Patients belonging to the STEMI group showed early elevations, in addition to higher mean reverse T3(rT3) and lower mean T3 and free T3 levels.[1] This syndrome has been reported to be found in severe chronic heart failure[2], in acute myocardial infarction[3,4] and as a rapidly emerging phenomenon during open-heart surgery.[5] hypothyroidism is emerging as a risk for coronary artery disease.[6]. Serum thyroid hormonal changes can occur in acute or chronic non-thyroidal systemic illness including acute coronary syndrome in otherwise euthyroid individuals. In this study we aimed to assess thyroid hormonal profile in patients presenting with acute coronary syndromes (ACS) and compare between ST segment elevated myocardial infarction and unstable angina/Non ST segment elevated myocardial infarction
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