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Hajje G, Saliba Y, Itani T, Moubarak M, Aftimos G, Farès N. Hypothyroidism and its rapid correction alter cardiac remodeling. PLoS One 2014; 9:e109753. [PMID: 25333636 PMCID: PMC4198123 DOI: 10.1371/journal.pone.0109753] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/06/2014] [Indexed: 01/12/2023] Open
Abstract
The cardiovascular effects of mild and overt thyroid disease include a vast array of pathological changes. As well, thyroid replacement therapy has been suggested for preserving cardiac function. However, the influence of thyroid hormones on cardiac remodeling has not been thoroughly investigated at the molecular and cellular levels. The purpose of this paper is to study the effect of hypothyroidism and thyroid replacement therapy on cardiac alterations. Thirty Wistar rats were divided into 2 groups: a control (n = 10) group and a group treated with 6-propyl-2-thiouracil (PTU) (n = 20) to induce hypothyroidism. Ten of the 20 rats in the PTU group were then treated with L-thyroxine to quickly re-establish euthyroidism. The serum levels of inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL6) and pro-fibrotic transforming growth factor beta 1 (TGF-β1), were significantly increased in hypothyroid rats; elevations in cardiac stress markers, brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) were also noted. The expressions of cardiac remodeling genes were induced in hypothyroid rats in parallel with the development of fibrosis, and a decline in cardiac function with chamber dilation was measured by echocardiography. Rapidly reversing the hypothyroidism and restoring the euthyroid state improved cardiac function with a decrease in the levels of cardiac remodeling markers. However, this change further increased the levels of inflammatory and fibrotic markers in the plasma and heart and led to myocardial cellular infiltration. In conclusion, we showed that hypothyroidism is related to cardiac function decline, fibrosis and inflammation; most importantly, the rapid correction of hypothyroidism led to cardiac injuries. Our results might offer new insights for the management of hypothyroidism-induced heart disease.
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Affiliation(s)
- Georges Hajje
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | - Youakim Saliba
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | - Tarek Itani
- Institut National de Pathologie, Baabda, Lebanon
| | - Majed Moubarak
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
| | | | - Nassim Farès
- Laboratoire de Recherche en Physiologie et Physiopathologie, Faculté de Médecine, Pôle Technologie Santé, Université Saint Joseph, Beirut, Lebanon
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Affiliation(s)
- Anthony Martin Gerdes
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, 1100 E 21st Street, Sioux Falls, SD 57105, USA.
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Tang YD, Kuzman JA, Said S, Anderson BE, Wang X, Gerdes AM. Low Thyroid Function Leads to Cardiac Atrophy With Chamber Dilatation, Impaired Myocardial Blood Flow, Loss of Arterioles, and Severe Systolic Dysfunction. Circulation 2005; 112:3122-30. [PMID: 16275864 DOI: 10.1161/circulationaha.105.572883] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although thyroid dysfunction has been linked to heart failure, it is not clear whether hypothyroidism alone can cause heart failure.
Methods and Results—
Hypothyroidism was induced in adult rats by treatment with 0.025% propylthiouracil (PTU) for 6 weeks (PTU-S) and 1 year (PTU-L). Echocardiographic measurements, left ventricular (LV) hemodynamics, isolated myocyte length (KOH method), myocardial blood flow (fluorescent microspheres), arteriolar morphometry, and gene expression (Western blot) were determined. Heart weight, heart rate, LV systolic blood pressure, LV ejection fraction, LV fractional shortening, and systolic wall thickness were reduced in PTU-S and PTU-L rats. LV internal diameter in systole increased by 40% in PTU-S and 86% in PTU-L. LV internal dimension in diastole was increased in PTU-S and PTU-L rats, but only PTU-L rats showed a significant increase in myocyte length due to series sarcomere addition. Resting and maximum (adenosine) myocardial blood flow were reduced in both PTU-S and PTU-L rats. Impaired blood flow was due to a large reduction in arteriolar length density and small arterioles in PTU-S and PTU-L (
P
<0.05 or greater for all of the above comparisons). Expression of sarcoplasmic/endoplasmic reticulum Ca
2+
-ATPase (SERCA)-2a and α-myosin heavy chain were reduced in hypothyroidism, whereas phospholamban and β-myosin heavy chain were increased.
Conclusions—
Hypothyroidism led to severe, progressive systolic dysfunction and increased chamber diameter/wall thickness ratio despite a reduction in cardiac mass. Chamber dilatation in PTU-L rats was due to series sarcomere addition, typical of heart failure. Hypothyroidism resulted in impaired myocardial blood flow due to a dramatic loss of arterioles. Thus, we have identified 2 important new mechanisms by which low thyroid function may lead to heart failure.
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Affiliation(s)
- Yi-Da Tang
- Cardiovascular Research Institute, South Dakota Health Research Foundation, University of South Dakota School of Medicine, Sioux Valley Hospitals and Health Systems, Sioux Falls, SD, USA
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Gerritsen RJ, van den Brom WE, Stokhof AA. Relationship between atrial fibrillation and primary hypothyroidism in the dog. Vet Q 1996; 18:49-51. [PMID: 8792593 DOI: 10.1080/01652176.1996.9694614] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Atrial fibrillation (AF) and primary hypothyroidism are most often diagnosed in middle-aged and older dogs of large and giant breeds. We hypothesized that the frequency of primary hypothyroidism may be higher in dogs with AF than in those without AF. Two groups were investigated. Group 1 (March 1987-June 1990) consisted of 128 dogs with AF. A thyroid-stimulating hormone (TSH) stimulation test was performed in dogs with a low voltage on the ECG and low uptake of pertechnetate on a thyroid scan. Group 2 (July 1990-July 1991) consisted of both dogs with AF (n = 38) and control dogs (n = 235) in which plasma thyroxine (T4) was measured. If T4 was below 15 nmol/l, a TSH stimulation test was performed. The frequencies of primary hypothyroidism in group 1 (8/128) and in the group 2 AF dogs (3/38) were not different, but were higher than in the control animals (3/235) (P < 0.05). The group 1 and the group 2 AF dogs were found to be comparable, and pooling of the data of the two groups enhanced the significance of the frequency of primary hypothyroidism in dogs with AF versus the control animals (11/166 versus 3/235) (P < 0.01). We concluded that the frequency of primary hypothyroidism in dogs with AF is higher than in the group of control dogs without AF. This may be due to the additional cardiovascular changes accompanying primary hypothyroidism in dogs that already have heart disease.
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Affiliation(s)
- R J Gerritsen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
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Abstract
Low QRS voltage on the 12-lead surface ECG is present when the amplitude of all six standard limb leads is less than 5 mm. This finding may be a normal variant, but necessitates investigation of the patient for an underlying cause. A variety of cardiac and systemic diseases may be responsible.
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Khaleeli AA, Memon N. Factors affecting resolution of pericardial effusions in primary hypothyroidism: a clinical, biochemical and echocardiographic study. Postgrad Med J 1982; 58:473-6. [PMID: 7134084 PMCID: PMC2426548 DOI: 10.1136/pgmj.58.682.473] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Echocardiography detected pericardial effusions in five out of six consecutive untreated patients with severe primary hypothyroidism and suspected myopathy, whereas the chest X-ray suggested only one. During L-thyroxine replacement, serial echocardiograms detected decrease in the size of the effusions in all the patients. This occurred before the serum thyroid stimulating hormone (TSH) levels had significantly changed, although there was a small but significant rise in serum thyroxine. In one patient complete resolution of the effusion occurred before the patient became euthyroid, a previously unreported finding. Small voltage complexes, T-wave inversion and non-specific T-wave flattening were the commonest electrocardiographic abnormalities noted. The former invariably and the latter two abnormalities frequently, reverted to normal before the patient became biochemically and clinically euthyroid. T-wave inversion in a particular lead, however, did not invariably do so, suggesting that permanent structural change might possibly have occurred. The plasma creatine kinase (CK) was raised in four patients, and markedly raised at levels usually associated with muscular dystrophy, in two. At the onset of resolution of the pericardial effusions, the total plasma CK had fallen significantly in all patients in whom it was raised.
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Abstract
Thirty-nine patients with untreated hypothyroidism have been examined using echocardiography for the presence of a pericardial effusion. Effusions were present in twelve patients who tended to be more severely hypothyroid. Plasma creatine phosphokinase and lactate dehydrogenase levels were higher in the presence of an effusion. Nine were reinvestigated during thyroxine replacement therapy and the effusions did not disappear until thyroid function tests had returned to normal. There were no specific electrocardiographic changes associated with the presence of an effusion which could be associated with a normal cardiac silhouette on a standard P.A. chest X-ray.
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Thomas J, Mills KB, Grisham DW. Primary myxedema heart disease. J Natl Med Assoc 1978; 70:833-6. [PMID: 722831 PMCID: PMC2537167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A case of primary myxedema heart disease in an 84-year-old man is presented. His history and physical examination were typical of myxedema. Electrocardiographic changes showing generalized low voltage, nonspecific S-T segment and T-wave changes, and nodal rhythm are characteristic of the disease. The patient showed remarkable improvement after oral liothyronine (Cytomel) therapy.
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Crowley WF, Ridgway EC, Bough EW, Francis GS, Daniels GH, Kourides IA, Myers GS, Maloof F. Noninvasive evaluation of cardiac function in hypothyroidism. Response to gradual thyroxine replacement. N Engl J Med 1977; 296:1-6. [PMID: 830262 DOI: 10.1056/nejm197701062960101] [Citation(s) in RCA: 166] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Left ventricular performance was studied in 15 patients with severe, primary hypothyroidism (mean serum total thyroxine of 0.8 mug per 100 ml and serum thyrotropin of 160 muU per milliliter). Pretreatment systolic-time intervals were characterized by prolongation of the pre-ejection period (delta PEP = +30) and reduction of the left ventricular ejection period (delta LVET = -23) with a resultant increase in the PEP/LVET ratio (0.47). Nine of 14 patients demonstrated pericardial effusions. These abnormalities were reversed with physiologic thyroxine replacement. Further reductions of the delta PEP and PEP/LVET ratio occurred with supraphysiologic doses (200 to 300 mug per day). During therapy, delta PEP was inversely correlated with serum thyroxine (P less than 0.001) and directly correlated with serum thyrotropin (P less than 0.001). Thus physiologic thyroid hormone replacement, appropriately adjusted to need, appears necessary in hypothyroidism for optimal left ventricular function.
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Freedberg AS, Papp JG, Williams EM. The effect of altered thyroid state on atrial intracellular potentials. J Physiol 1970; 207:357-69. [PMID: 5499024 PMCID: PMC1348711 DOI: 10.1113/jphysiol.1970.sp009066] [Citation(s) in RCA: 172] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
1. A group of rabbits was made hypothyroid by thyroidectomy, and another group was injected daily with L-thyroxine. After an appropriate interval respective alterations in thyroid state were confirmed by measurement of heart weight and of plasma iodine, and the animals' atria were isolated for recording.2. Measurements were made of atrial contractions, conduction velocity, spontaneous heart rate and maximum driven frequency, and action potentials were recorded with intracellular micro-electrodes.3. The resting potential and action potential heights were not affected by differences of thyroid state.4. Atrial arrhythmias are common in hyperthyroidism, rare in myxoedema. The possibility that hypothyroidism might reduce the rate of rise of the action potential, as do anti-arrhythmic drugs, and hyperthyroidism increase it, was investigated. Although the rate of rise was slower in hypothyroid atria at some driving frequencies, this could not alone account for an anti-arrhythmic effect, because at frequencies near the spontaneous heart rate the rate of rise of the action potential was not reduced.5. The duration of the repolarization phase of the action potential was greatly prolonged in atria from thyroidectomized rabbits, and was shortened in hyperthyroid atria. These changes could account for a reduced probability of arrhythmias in hypothyroidism, and the converse in hyperthyroidism.
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Weir RJ, Young JA, McGuinness JB. Changes in the electrocardiogram and achilles reflex test during treatment of hypothyroidism. Scott Med J 1969; 14:59-63. [PMID: 5767386 DOI: 10.1177/003693306901400206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 10 patients with hypothyroidism, the electrocardiogram and Achilles reflex test have been recorded before and during treatment with l-thyroxine sodium. Aspects of the electrocardiogram affected by hypothyroidism are the rate, duration of PR interval, height of P-wave, of QRS complex and of T-wave and the ST segment. Each of these improved with therapy, the earliest and most sensitive change being the height of the QRS complex. The Achilles reflex time as recorded by the photomotograph also showed a parallel decrease with therapy but this is considered to be less reliable as an isolated test. The prolongation of the PR interval is briefly discussed and a correlation between the changes in skeletal and myocardial muscle is suggested.
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WIETERSEN FREDK, BALOW ROSSM. THE RADIOLOGIC ASPECTS OF THYROID DISEASE. Radiol Clin North Am 1967. [DOI: 10.1016/s0033-8389(22)02753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aber CP, Noble RL, Thompson GS, Jones EW. Serum lactic dehydrogenase isoenzymes in "myxoedema heart disease". BRITISH HEART JOURNAL 1966; 28:663-73. [PMID: 5916476 PMCID: PMC459101 DOI: 10.1136/hrt.28.5.663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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