The Association of Autoantibodies in Hyperthyroid Heart Disease Combined with Pulmonary Hypertension

The association between renin and thyroid-related biomarkers with clinical characteristics and outcomes in hyperthyroid patients

ObjectiveThere is crosstalk between the thyroid hormone and the renin-angiotensin-aldosterone system, but the clinical application is lacking. Our study aimed to verify the correlation between renin and other thyroid-related biomarkers and their association with treatment prognosis.MethodsThis retrospective study recruited eighty consecutive patients treated for hyperthyroidism in a medical center between 2021 and 2023. Among participants, 53 were newly diagnosed, and 27 were recurrent cases. Laboratory measurements, including renin, aldosterone, and other thyroid-related biomarkers, were assessed, while the associations of biomarkers and clinical symptoms were also analyzed. The clinical variables and biomarkers were entered into the Cox regression model to identify the independent risks associated with time to achieve euthyroidism.ResultsThe correlation matrix showed that free T4 was positively correlated either with T3 (r = 0.755, P < 0.001) or renin (r = 0.341, P = 0.002) but not with aldosterone (r = 0.055, P = 0.631). In ROC analysis for biomarkers and clinical symptoms, either free T4 (AUC = 0.754, P < 0.001) or thyroid-stimulating hormone receptor antibody (TSHRAb) (AUC = 0.645, P = 0.026) demonstrated effective prediction of tachycardia; however, renin was slightly positive for tachycardia without significance (AUC = 0.580, P = 0.233). Regarding thyrotoxic periodic paralysis, the renin showed significant prediction power (AUC = 0.727. P = 0.021) rather than free T4 (AUC = 0.543, P = 0.748) or TSHRAb (AUC = 0.688, P = 0.063). The median time to achieve euthyroidism was 166 days for newly onset patients and 216 days for recurrence, but the time-to-event curves showed no difference (log rank P = 0.728). Under Cox regression modeling, TSHRAb was found to independently predict late euthyroidism (Hazard ratio 0.946, 95% confidence interval 0.901-0.993, P = 0.026), and the renin had no impact (HR 0.995, 95% CI 0.987-1.003, P = 0.215).ConclusionsRenin but not aldosterone was positively correlated with free T4. Certain biomarkers measured at diagnosis were associated with hyperthyroid symptoms. Free T4 and TSHRAb might predict tachycardia, while renin might predict thyrotoxic periodic paralysis; nevertheless, only higher TSHRAb was associated with delayed euthyroid state achievement.

Is Low-free Triiodothyronine (fT3) Associated with Increased Morbidity in Patients Admitted to Coronary Care Units?

BACKGROUND

The effects of thyroid hormone on patients hospitalized in coronary intensive care units are still controversial.

OBJECTIVE

We retrospectively examined thyroid hormone levels and their impact on cardiovascular morbidity in patients admitted to coronary intensive care units.

METHODS

A total of 208 (Female/Male; 46.6%/53.4%) patients without any history of thyroid disease were enrolled and screened. Patients with specific heart disease and existing thyroid hormone parameters were included in the study. Low triiodothyronine syndrome is characterized by reduced serum total or free T3 (fT3) concentrations in normal free T4 (fT4) and TSH levels.

RESULTS

The common diagnosis of the patients in the coronary care unit is acute coronary syndrome (n = 59, 28.2 %) and heart failure (n = 46, 23.3%). Patients were divided into two groups according to left ventricular ejection fraction percentages (LVEF ≤39% vs LVEF ≥40%). Plasma fT3 levels were significantly correlated with low LVEF (≤39%) (p =0.002). fT3 (r = -0.183, p =0.013) and hospitalization etiology (r = -0.161, p =0.023) were also the most critical parameters affecting the length of hospitalization.

CONCLUSION

Low fT3 was associated with reduced ejection fraction and prolonged hospitalization, which may lead to potential morbidities in HF patients and may be useful in risk stratification and treatment strategies.

Cardioprotective mechanism of Qixuan Yijianing formula in Graves' disease mice using miRNA sequencing approach

OBJECTIVE

To investigate the mechanism of Qixuan Yijianing (,QYN) in minimizing cardiac injury in Graves' disease (GD) mice using microRNA (miRNA) sequencing analysis.

METHODS

Female BALB/c mice were randomly divided into the modeling and control groups (CG). The modeling group was established with Ad-TSHR289. Following 10 weeks of successful modeling, the mice were randomly assigned to four groups: model (MG), methimazole (MMI), QYN low-dose (LD), and high-dose (HD). After four weeks of treatment, the heart rate, heart volume, and heart index were measured, and the levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBD), creatine kinase (CK), and creatine kinase MB isoenzyme (CK-MB) in the serum were detected using a biochemical analyzer. Hematoxylin-eosin and Masson staining were used to determine histological changes in cardiac tissue. The heart tissues in the CG, MG, and HD groups were selected, and miRNA sequencing was used to identify differentially expressed miRNAs. A bioinformatics database was used to predict the target genes of differential miRNAs, and Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were conducted on the predicted target genes.

RESULTS

As compared to the CG group, the MG group's heart rate, heart volume, heart index, AST, CK, CK-MB, LDH, α-HBD, myocardial fiber thickness, and collagen fiber significantly increased, all P < 0.01, while following QYN, these indicators improved in the HD group, all P < 0.01 or P < 0.05. Compared to the CG group, the MG group identified 151 differentially expressed miRNAs, with 42 miRNAs downregulated and 109 miRNAs upregulated; compared to the MG group, the HD group identified 70 differentially expressed miRNAs, 40 were downregulated, and 30 were upregulated. The GO functions of differential miRNA target genes are mostly enriched in cardiac development regulation, cardiac contraction control, heart rate regulation, and so on. The most enriched KEGG pathways include the mitogen-activated protein kinase, ErbB, Hippo, forkhead box protein O, and Wnt signaling pathways.

CONCLUSION

QYN may protect the cardiac structure and function and minimize cardiac damage caused by GD by regulating relevant target genes and signaling pathways through miRNAs which include miR-206-3p, miR-122-5p, and miR-200a-3p.

The clinical characteristics and outcomes of patients with pulmonary hypertension in association with hyperthyroid state: A systematic review

BACKGROUND

Pulmonary hypertension (PHTN) may occur in thyroid disorders, especially in hypothyroidism. However, there is increasing evidence of PHTN in hyperthyroidism (HTH). The etiology, clinical course, management, and factors associated with outcomes of PHTN in the setting of HTH are unascertained. This systematic review consolidates available evidence on patients with HTH who developed PHTN.

METHODS

We conducted a systematic review on English articles from PubMed, Scopus, and Google Scholar reporting PHTN in patients with hyperthyroidism. Data were analyzed and reported in Microsoft Excel 2020, SPSS version 26, and Jamovi version 1.2.

RESULTS

We identified 589 patients with PHTN in the setting of HTH. Etiologies included Grave disease 66.7%), toxic multinodular goiter (TMNG) (16.8%), drug-induced HTH (0.3%), thyroiditis(0.8%), and toxic adenoma(0.1%). Most patients did not receive any specific management for PHTN and were managed by antithyroid treatment (97.4%). Outcomes of PHTN were reported in 181 patients, with a 94% recovery rate. Pulmonary artery pressures (PAP) before and after HTH management ranged from 22.5 to 75 mm Hg and from 24 to 50 mm Hg, respectively. Outcome analysis performed on data from case reports and series with individually identifiable data revealed a 67.6% female preponderance. An estimated 73.5% of the patients had PHTN at the initial presentation of HTH, which was associated with a better resolution rate of PHTN(OR: 12, P-value: 0.048). TRAB was positive in 47% patients with no clinical difference in outcomes. antiTG AB was reported positive in 29.4%, all of whom had an improvement, compared to an 83.3% improvement rate in those with negative antiTG AB. Various etiologies and treatments did not have any significant differences in the outcome of PHTN.

CONCLUSIONS

PHTN can be present at the initial diagnosis of HTH, which is associated with better outcomes of PHTN. There is a clear female preponderance in the development of PHTN. However, resolution rates seem to be better in males. Although TRAB is associated with the development of PHTN, it does not seem to affect the outcomes. PHTN in patients with HTH does not need any specific management, with >90% resolution with antithyroid therapy. Whether any specific antithyroid therapy has a better outcome in PHTN needs to be explored prospectively.

Association of Plasma Connective Tissue Growth Factor Levels with Hyperthyroid Heart Disease

Hyperthyroid heart disease (HHD) is one of the most severe complications of overt hyperthyroidism and increases the risk of mortality in affected patients. Early identification of patients at a higher risk of developing HHD can improve clinical outcomes through active surveillance and management. Connective tissue growth factor (CTGF), a secreted extracellular protein, plays a significant role in cardiac remodeling and dysfunction. We aimed to investigate the association between plasma CTGF level and the risk of HHD in this study. A total of 142 overt hyperthyroid patients without HHD and 99 patients with HHD were included. The plasma CTGF levels were measured using ELISA kits. Routine clinical medical data and echocardiography parameters were recorded for analysis. The plasma CTGF level was significantly higher in patients with HHD than in those without HHD (P=0.002). The plasma CTGF level was positively correlated with free triiodothyronin, tryrotropin receptor antibody, troponin I and lactate dehydrogenase levels and the left atrium diameters, right atrium diameters, and right ventricular end-diastolic diameters (all P<0.05). Logistic regression analysis showed that quartiles 3 and 4 of plasma CTGF levels were significantly associated with the increased risk of HHD (crude OR: 2.529; 95% CI: 1.188-5.387). However, after adjustment for the potentially confounding variables, quartile 4 alone was significantly associated with the higher risk of HHD relative to quartile 1. Hyperthyroid patients with HHD display higher plasma CTGF levels. Furthermore, CTGF is an independent risk factor for HHD. Therefore, the plasma CTGF level may be a potential biomarker for the risk of HHD.