Alterations In Left Ventricular Diastolic Function In Hypothyroidism
Diastolic Dysfunction in Hypothyroidism
Keywords:
Hypothyroidism, Left ventricular, pericardial effusion, diastolic dysfunctionAbstract
Background and Objectives: Hypothyroidism decreases the heart rate, cardiac output and
myocardial contractility. Altered intracellular Calcium handling results in left ventricular diastolic dysfunction in
hypothyroidism. Methods: 33 cases of primary hypothyroidism and 33 age (+/_ 5 years) and sex matched
healthy controls were studied. Thyroid profile and 2 D Echocardiography was done in all patients. Pulsed wave
Doppler examination to study the diastolic transmitral flow velocities was done to assess the left ventricular
diastolic function. Results: There was female preponderance (male to female ratio of 1:7.25), weight gain
(60.60% cases) being the most frequent presenting symptom. The mean BMI and mean systolic and diastolic
blood pressure were significantly increased in the cases (p<0.05). Hypothyroid patients had significant
bradycardia (p<0.05). 7(21.21%) patients had pericardial effusion. Statistically significant difference was found
in the IVST, PWT, IVRT and DT (p<0.05); the trans-mitral ‘A’ wave velocity was significantly increased in cases
(72.13 +/-13.27 Vs 65.48 =/-9.345; p=0.022). The ratio of E: A was significantly decreased in the hypothyroid
group (1.23 in cases and 1.38 in controls; p=0.011). Interpretation and Conclusion: Hypothyroidism results in
left ventricular structural changes in the form of concentric remodelling, pericardial effusion and left
ventricular diastolic dysfunction. [ Deoke S NJIRM 2014; 5(2) :66-70]
References
Kranias EG. Thyroid hormone induced
alterations in phospholamban-deficient mouse
hearts. Circ Res 1998; 83: 608–613.
2. Fazio S, Palmieri EA, Lombardi G, Biondi B.
Effects of thyroid hormone on the
cardiovascular system. Recent Prog Horm Res
2004; 59: 31-50.
3. Osman F, Gammage MD, Franklyn JA. Thyroid
disease and its treatment: short-term and longterm
cardiovascular
consequences. Curr Opin Pharmacol 2001; 1:
626–631
4. Owen PJ, Sabit R, Lazarus JH. Thyroid disease
and vascular function. Thyroid 2007. 17; 6: 519-
24.
5. Iqbal A, Schirmer H, Lunde P, Figenschau Y,
Rasmussen K, Jorde R. Thyroid Stimulating
Hormone and Left Ventricular Function. The
Journal of Clinical Endocrinology & Metabolism
2007; 92(9): 3504-3510.
6. Ciulla M, Paliotti R, Tortora R, Valentini P,
Cortelazzi B, Beck-Peccoz P. Myocardial
ultrasonic reflectivity in patients with thyroid
dysfunction: a tissue characterization study.
Cardiovascular Imaging 1997; 9: 75-77.
7. Fabrizio AL, Vitantonio DB, Enrica T, Andrea DC,
Fabio M, Lucia A, et al. Early textural and
functional alterations of left ventricular
myocardium in mild hypothyroidism. European
Journal of Endocrinology 2006; 155: 3-9.
8. Hoftijzer HC, Bax JJ, Heemstra KA, Bleeker GB,
Delgado V, van der Klaauw AA, et al. Short-term
overt hypothyroidism induces discrete diastolic
dysfunction in patients treated for
differentiated thyroid carcinoma. Eur J Clin
Invest 2009; 39 (3): 204-210.
9. Kakhki VRD, Nezhad AF, Zakavi SR, Rahmani E,
Sadeghi R, Ayati NK. Echocardiographic left
ventricular functional changes in acute
hypothyroidism vs subclinical hyperthyroidism
in patients with differentiated thyroid
carcinoma. Iran J Nucl Med 2011; 19 (2): 28-37.
10. Mishra TK, Routray SN, Das S, Behera M. Left
ventricular dysfunction in patients with
subclinical hypothyroidism and its reversibility
after hormone therapy. JAPI 2005; 53: 943-946.
11. Erkan G, Erkan AF, Cemri M, Karaahmetoglu S,
Cesur M, Cengel A. The Evaluation of Diastolic
Dysfunction with Tissue Doppler
Echocardiography in Women with Subclinical
Hypothyroidism and the Effect of L-Thyroxine
Treatment on Diastolic Dysfunction : A Pilot
Study. Journal of Thyroid Research 2011; Article
ID 654304, 7 pages, doi 10.4061/2011/654304.
12. Toft AD, Boon NA. Thyroid disease and the
heart. Heart 2000; 84: 455-460.
13. Matsukawa T, Mano T, Gotoh E, Minamisawa K,
Ishii M. Altered sympathetic nerve activity in
hyperthyroidism and hypothyroidism. Journal ofthe Autonomic Nervous System 1993; 42: 171-
175
14. Manhem P, Bramnert M, Hallengren G.
Increased arterial and venous plasma
noradrenaline levels in patients with primary
hypothyroidism during hypothyroid as ompared
with euthyroid state. Journal of
Endocrinological Investigation 1992; 15: 763-
765.
15. Cacciatori V, Gemma ML, Bellavere F, Castello R,
Gregori MED, Zoppini G, et al. Power spectral
analysis of heart rate in hypothyroidism.
European Journal of Endocrinology 2000; 143:
327-333.
16. Bing RF, Briggs RSJ, Burden AC, Russel AC, Swaks
JD, Thurston H. Reversible hypertension and
hypothyroidism. Clinical Endocrinology 1980;
13: 339-342.
17. Rodondi N, Bauer DC, Cappola AR et al.
Subclinical thyroid dysfunction, cardiac
function, and the risk of heart failure. The
Cardiovascular Health study. Journal of the
American College of Cardiology 2008; 52, (14):
1152–1159.
18. Biondi B, Fazio S, Palmieri EA, Carella C, Panza
N, Cittadini A, et al. Left ventricular diastolic
dysfunction in patients with subclinical
hypothyroidism. J Clin Endocrinol Metab 1999;
84 (6): 2064–2067.
19. Virtanen VK, Saha HHT, Groundstroem KWE,
Salmi J, Pasternack AI. Thyroid hormone
substitution therapy rapidly enhances left
ventricular diastolic function in hypothyroid
patients. Cardiology 2001; 96: 59-64.
20. Gupta A, Sinha RSK. Echocardiographic changes
and alterations in lipid profile in cases of
subclinical and overt hypothyroidism. JAPI 1996;
44 (8): 546-553.
21. Rawat B, Satyal A. An Echocardiographic study
of cardiac changes in hypothyroidism and the
response to treatment. Kathmandu University
MedicalJournal 2003; 2 (3): 182-187.
