BIOCHEMICAL EFFECT OF THYROID HORMONES ON HEART FAILURE

Dysthyroidism affects cardiovascular function in many ways and can cause heart failure. The physiopathological mechanisms underlying the development of heart failure involve both direct intranuclear transcriptional effects of thyroid hormones and specific haemodynamic consequences of vascular modifications induced by dysthyroidism. Phospholamban regulatory action on diastolic ventricular function appears to play a pivotal role in mediating both direct T3 action and adrenal effects on myocardial contractility, possibly explaining the way dysthyroidism mimics sympathoadrenergic alterations on cardiovascular function. Therapeutical approach to cardiovascular disorders in dysthyroidism should focus on both thyroid hormones dysregulation and sympathoadrenergic activity, to attempt a reversal of the associated derangements.

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The Role of Thyroid Hormones in Heart Failure

Cardiovascular Drugs and Therapy ◽

10.1007/s10557-019-06870-4 ◽

2019 ◽

Vol 33 (2) ◽

pp. 179-188 ◽

Cited By ~ 8

Author(s):

Catarina Vale ◽

João Sérgio Neves ◽

Madalena von Hafe ◽

Marta Borges-Canha ◽

Adelino Leite-Moreira

Keyword(s):

Heart Failure ◽

Thyroid Hormones

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Prospects for the use of thyroid hormones in patients with heart failure

Ukrainian Therapeutical Journal ◽

10.30978/utj2021-2-74 ◽

2021 ◽

Author(s):

S. M. Pyvоvar ◽

Yu. S. Rudyk ◽

О. B. Krоtоva ◽

L. V. Panina

Keyword(s):

Heart Failure ◽

Thyroid Hormone ◽

Thyroid Hormones ◽

Animal Studies ◽

Cardiac Tissue ◽

Contractile Function ◽

Heart Function ◽

Experimental Studies ◽

Tissue Level ◽

Free Triiodothyronine

Thyroid hormone therapy in the setting of heart failure is still an «open book» today. There are several unanswered questions: the regimen, doses and schedule of the use of thyroid hormones, the consequences of such therapy. At the same time, the presence of a comorbid pathology of the thyroid gland, which requires the appointment of levothyroxine, allows one to partially answer these questions. Thyroid hormones affect the diastolic and systolic functions of the myocardium. Ventricular contractile function is also affected by changes in hemodynamic conditions secondary to thyroid hormones and peripheral vascular tone. Thyroid hormone homeostasis maintains a positive ventricular-arterial ratio, resulting in a favorable balance for heart function. Experimental studies in rats have shown that chronic hypothyroidism alone can eventually lead to heart failure. Other studies suggest a decrease in the level of free triiodothyronine in the myocardium after myocardial infarction or with arterial hypertension due to the activation of type 3 deiodinase, which leads to deactivation of triiodothyronine and thyroxine. To address these issues, the researchers propose conducting multicenter, randomized, placebo-controlled trials to evaluate the effects of thyroxine replacement in patients with chronic heart failure. The review highlights the growing body of evidence from animal studies and small clinical trials that suggests that low thyroid activity at the cardiac tissue level can negatively affect the progression of heart failure and that treatment with thyroid hormones can lead to an improved prognosis.

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B-type natriuretic peptide increases cortisol and catecholamine concentrations in healthy subjects

Journal of Applied Physiology ◽

10.1152/japplphysiol.00360.2016 ◽

2017 ◽

Vol 122 (5) ◽

pp. 1249-1254 ◽

Cited By ~ 3

Author(s):

Gabriele Grimm ◽

Michael Resl ◽

Birgit B. Heinisch ◽

Martin Hülsmann ◽

Anton Luger ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Thyroid Hormones ◽

Natriuretic Peptide ◽

Elevated Serum ◽

Endocrine System ◽

Serum Cortisol ◽

Neuroendocrine Activation ◽

The Impact

B-type natriuretic peptide (BNP) is a hormone released by the heart in response to volume load and exerts natriuretic properties. It is clinically used as a diagnostic and prognostic biomarker and investigated as a pharmacological agent in the therapy of heart failure. Here we investigate the changes in pituitary, adrenal, and thyroid hormones in response to BNP administration in a randomized single-blinded crossover study conducted in ten healthy men aged 21–29 yr. Participants received in two study sessions a continuous intravenous infusion during 4 h (once placebo and once 3 pmol·kg−1·min−1 BNP) and remained in supine position throughout the study. Circulating concentrations of pituitary, adrenal, and thyroid hormones, heart rate, and blood pressure were measured at baseline and hourly afterwards. BNP prevented the physiological decrease in cortisol during the late morning hours leading to elevated serum cortisol levels ( P = 0.022) and increased circulating epinephrine and norepinephrine concentrations ( P = 0.018 and P = 0.036, respectively). These hormone changes were accompanied by an increase in heart rate ( P = 0.019) but no differences in blood pressure. Taken together, the impact of BNP on the endocrine system extends beyond the well-known inhibition of the renin-angiotensin-aldosterone system and includes increased adrenergic activity and cortisol concentrations. This neuroendocrine activation might impact the outcome of therapeutical BNP administrations and should be further investigated in conditions associated with increased BNP secretion. NEW & NOTEWORTHY The heart hormone B-type natriuretic peptide (BNP) is increased in patients with heart failure, where it is thought to have beneficial effects by reducing the preload. Here we report that intravenous administration of BNP in men leads to increases in adrenal hormones cortisol, epinephrine, and norepinephrine. Cortisol and catecholamine levels are independent predictors of increased cardiovascular mortality risk; therefore, drugs targeting the BNP system should be evaluated regarding their effects on the neuroendocrine activation accompanying heart failure.

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Prevalence and Risk Factors of Left Ventricular Diastolic Dysfunction in Patients With Hyperthyroidism

Frontiers in Endocrinology ◽

10.3389/fendo.2020.605712 ◽

2021 ◽

Vol 11 ◽

Author(s):

Huan Li ◽

Renli Zeng ◽

Yunfei Liao ◽

Mengfei Fu ◽

Huan Zhang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Thyroid Hormones ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Ventricular ◽

Obese Patients ◽

Control Subjects ◽

Lv Diastolic Dysfunction ◽

Overt Hyperthyroidism

BackgroundLeft ventricular (LV) diastolic dysfunction has been demonstrated to be an independent predictor of the future heart failure. Heart failure is one of the severe complications caused by overt hyperthyroidism. However, the effects of overt hyperthyroidism on diastolic dysfunction are conflicting, and little is known about the prevalence and risk factors of the diastolic dysfunction in patients with overt hyperthyroidism.MethodsA total of 388 patients with overt hyperthyroidism were included and compared with 388 age- and gender- matched euthyroid control subjects. LV diastolic function was evaluated by traditional and tissue-Doppler echocardiography. Routine clinical medical data and echocardiographic parameters were recorded for analysis.ResultsThe prevalence of LV diastolic dysfunction was 35.1% among hyperthyroid patients and significantly higher than control subjects whose prevalence was 25.5% (P = 0.003), and it increased with age and body mass index (BMI) in patients with overt hyperthyroidism. The possible risk factors for LV diastolic dysfunction, such as hypertension, diabetes, decreased estimated glomerular filtration rate (eGFR), and increased level of thyroid hormones weren’t associated with LV diastolic dysfunction. However, overweight or obese were significantly associated with LV diastolic dysfunction (OR = 3.024, 95% CI = 1.517–6.027, P = 0.002) compared with normal BMI. When compared with age <40 years old group, 40-50 years old group, 50-60 years old group and age ≥60 years old group were significantly associated with LV diastolic dysfunction, with ORs of 2.976 (95% CI = 1.744–5.019), 12.424 (95% CI = 4.934–31.283), 24.966 (95% CI = 5.975–104.321), respectively.ConclusionLV diastolic dysfunction was very common, in particular, in older and overweight or obese patients with overt hyperthyroidism. Additionally, age and BMI were independent risk factors for LV diastolic dysfunction, while the level of thyroid hormones was not. Therefore, besides the LV systolic function, we also need focus on the diastolic function in patients with overt hyperthyroidism in clinical work, especially the older and overweight or obese patients.

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