Both exogenous subclinical hyperthyroidism and short-term overt hypothyroidism affect myocardial strain in patients with differentiated thyroid carcinoma

Abdulrahman, Randa M., Delgado, Victoria, Hoftijzer, Hendrieke C., Ng, Arnold C. T., Ewe, See Hooi, Marsan, Nina Ajmone, Holman, Eduard R., Hovens, Guido C., Corssmit, Eleonora P., Romijn, Johannes A., Bax, Jeroen J. and Smit, Johannes W. A. (2011) Both exogenous subclinical hyperthyroidism and short-term overt hypothyroidism affect myocardial strain in patients with differentiated thyroid carcinoma. Thyroid, 21 5: 471-476. doi:10.1089/thy.2010.0319


Author Abdulrahman, Randa M.
Delgado, Victoria
Hoftijzer, Hendrieke C.
Ng, Arnold C. T.
Ewe, See Hooi
Marsan, Nina Ajmone
Holman, Eduard R.
Hovens, Guido C.
Corssmit, Eleonora P.
Romijn, Johannes A.
Bax, Jeroen J.
Smit, Johannes W. A.
Title Both exogenous subclinical hyperthyroidism and short-term overt hypothyroidism affect myocardial strain in patients with differentiated thyroid carcinoma
Journal name Thyroid   Check publisher's open access policy
ISSN 1050-7256
1557-9077
Publication date 2011-05
Year available 2011
Sub-type Article (original research)
DOI 10.1089/thy.2010.0319
Volume 21
Issue 5
Start page 471
End page 476
Total pages 6
Place of publication New Rochelle, NY United States
Publisher Mary Ann Liebert
Collection year 2011
Language eng
Formatted abstract
Background: The cardiovascular effects of transitions from exogenous subclinical hyperthyroidism to short-term overt hypothyroidism in patients treated for differentiated thyroid carcinoma remain unclear. The present study aims at evaluating the changes in multidirectional myocardial strain using two-dimensional (2D) speckle tracking during this controlled transition from exogenous subclinical hyperthyroidism to overt hypothyroidism.

Methods:
The study included 14 patients with differentiated thyroid carcinoma on thyrotropin suppressive thyroxine substitution who were subsequently withdrawn from thyroxine for 4 weeks. Cardiac function was assessed by 2D speckle tracking echocardiography before and 1 and 4 weeks after withdrawal and compared with values obtained in a control group of 24 individuals.

Results: At baseline, the left ventricular dimensions were significantly higher in patients as compared with controls. Using 2D speckle tracking imaging, the patients had significantly impaired baseline myocardial systolic function in the circumferential (-16.0% ± 2.1% vs. -19.2% ± 3.0%, p = 0.001) and longitudinal (-17.1% ± 2.5% vs. -19.7% ± 3.0%, p = 0.001) directions as compared with controls. Withdrawal of thyroid hormone did not induce significant changes in left ventricular dimensions or systolic function. During the transition from exogenous subclinical hyperthyroidism to overt hypothyroidism, a significant improvement in circumferential and longitudinal systolic shortening was observed and returned to abnormal values when the patients were overt hypothyroid (circumferential strain: from -16.0% ± 2.1% to -18.6% ± 1.9% and -14.7% ± 2.8%, p < 0.005; longitudinal strain: from -17.1% ± 2.5% to -18.8% ± 1.4% and -16.3% ± 1.3%, p < 0.005).

Conclusions:
A U-shaped relationship between a range of thyroid hormone levels (from hyper- to hypothyroid concentrations) and myocardial strains was observed. The clinical consequences of these findings remain to be determined but may point out an increased myocardial vulnerability even in states of moderate subclinical hyperthyroidism and short-term hypothyroidism.
Keyword Quality of life
Diastolic Dysfunction
Echocardiographic-Assessment
Ventricular Function
Hormone
Doppler
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Sun, 14 Apr 2013, 23:54:41 EST by Dr Chin Tse Arnold Ng on behalf of Medicine - Princess Alexandra Hospital