Title: Evaluation of the Echocardiographic Findings in cases of Thyroid Disorders
Authors: B. S. Bal, Ashok Duggal, Mandeep Kaur, Tajinder Kaur, Rajvir Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.98
Abstract
Background: Thyroid disorders are known to cause cardiac complications and increases risk of cardiac morbidity and mortality. This study aimed to identify echocardiographic changes in thyroid disorders.
Methods: Data was examined from 90 patients by dividing into three groups having 30 patients in each group as hyperthyroid, hypothyroid and control group respectively. Echocardiography was done before initiation of therapy and after 12 weeks of therapy.
Result: Diastolic dysfunction was seen in both Hyperthyroid (13.33%) and Hypothyroid (46.67%) with more prevalence in Hypothyroid group, MR was common in Hyperthyroid group (20%), Hypothyroid group (13%). The flow velocities with hypercontractile heart (20%), pulmonary hypertension (20%), concentric LVH (10%), irregular rhythm and mild pericardial effusion (3.3%) in Hyperthyroid group. In Hypothyroid group pericardial effusion (23.3%), concentric LVH (23.3%), asymmetric hypertrophyof septum (3.3%), dilated LV (3.3%) was seen. All changes reverted significantly after 12 weeks of therapy and it was statistically significant (p<0.05).
Conclusion: Early echocardiography in patients of thyroid disorders is helpful for early diagnosis of cardiac complications associated with it and timely prevention.
References
1. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med.2000;160:526-530
2. Klein, I, K. Ojamaa. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7) :501-9
3. Dillmann WH. Cellular action of thyroid hormone on the heart. Thyroid2002; 12:447-452.
4. Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of thyroid hormone on cardiac function: the relative importance of heart rate, loading conditions, and myocardial contractility in the regulation of cardiac performance in human hyperthyroidism. J Clin Endocrinol Metab. 2002;87:968-974.
5. Levey GS, Klein I. Disorders of the thyroid. In: Stein’s Textbook of Medicine, 2nd ed. Boston, Mass: Little Brown & Co.: 1994:1383.
6. Prisant LM, Gujral JS, Mulloy AL. Hyperthyroidism: a secondary cause of isolated systolic hypertension. J Clin Hypertens. 2006;8:596-599.
7. Crowley WF Jr, Ridgway EC, Bough EW, Francis GS, Daniels GH, Kourides IA, Myers GS, Maloof F. Noninvasive evalua-tion of cardiac function in hypothyroidism. Response to gradual thyroxine replace-ment. N Engl J Med.1977;296:1-6.
8. Klein I. Endocrine disorders and cardiovascular disease. In: Zipes DP, Libby P, Bonow R, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, Pa. WB. Saunders;2005:2051-2065.
9. Maia AL, Kim BW, Huang SA, Harney JW, Larsey PR. Type 2 Iodothyronin-edeiodinase is the major source of plasma T3 in euthyroid humans. J Clin Invest 2005;115:2524-2533
10. Bianco AC, Salavatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, cellular and molecular biology, and physiological roles of iodothyronineselen-odeiodenases. Endocrine Rev.2002;23:38-89
11. Everts ME, Verhoeven FA, Bezstarsti K, Moerings EP, Hennemann G, Visser TJ, Lamers JM. Uptake of thyroid hormones in neonatal rat cardiac myocytes. Endocrinology.1996;137: 4235-4242.
12. Hartong R, Wang N, Kurokawa R, Lazar MA, Glass CK, Apriletti, Dillmann WH. Delineation of three different thyroid hormone- response elements in promoter of rat sarcoplasmic reticulum Ca2+- ATPase gene. J Biol Chem.1994; 269:13021-29.
13. Mintz G, Pizzarello R, Klein I. Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment. J Clin Endocrinol Metab. 1991;73: 146-150.
14. Kiss E, Jakab G, Kranias EG, Edes I. Thyroid hormone-induced alterations in phospholamban protein expression: regulatory effects on sarcoplasmic reticulum Ca2+transport and myocardial relaxation. Circ Res. 1994;75:245-251.
15. Ayhan S, Ozturk S, Dikbas O, et al. Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism.Arch Cardiovasc Dis.2012 ;105(12):631-8.
16. Tadic M, Ilic S, Cuspidi C, et al. Subclinical hyperthyroidism impacts left ventricular deformation: 2D and 3D echocardiographic study. Sc and Cardiovasc J. 2015 Apr;49(2):74-81.
17. Sokmen A, Acar G, Sokmen G, et al.Evaluation of atrial electromechanical delay and diastolic functions in patients with hyperthyroidism.Echocardiography. 2013 Nov;30(10):1194-201.
18. Vanderpump MPJ, Tunbridge WMG, French JH. The incidence of thyroid disorders in a community: a twenty year follow-up of Whickham survey. Clin Endocrinol (Oxf) 1995; 43: 55- 68.
19. Larsen PR, Davies TF. Hypothyroidism and thyroiditis. Williams Textbook of Endocrinology. 10th ed. Philadelphia: WB Saunders. 2003; 423-5.
20. Cacciatori, V. Power spectral analysis of heart rate in hyperthyroidism. J Clin Endocrinol Metab. 1996; 81(8): 2828-35.
21. LeyeA , Fall S. Non iatrogenic primary hypothyroidism in adults at le dantechospital:clinical features, diagnosis and treatment. Review of 19 cases. Dakar Med 2004;49(2): 110-3.
22. Klein, I, K. Ojamaa. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7) :501-9.
23. Kage K, Kira Y, SekineI,et al.High incidence of mitral and tricuspid regurgitation in patients with Graves' disease detected by two-dimensional color doppler echocardiography. Intern Med. 1993 May;32(5):374-6.
24. Merillon JP, Passa PH, Chastre J et al. Left ventricular function in hyperthyroidism. Br heart J.1981; 46:137-143.
25. Freedberg AS. Popp JGY, Williams EMV. The effect of altered thyroid state on atrial intracellular potentials. J Physiol. 1970; 357-369.
26. Karabag T, Dogan SM, Bayraktaroğlu T, et al. Assessment of left atrial mecha-nical functions in thyroid dysfunction.Pol Arch Med Wewn. 2013;123(11):596-602.
27. Biondi B, Palmieri E, Lombardi G, et al. Subclinical hypothyroidism and cardiac function. Thyroid.2002; 12:505-510.