Hypothyroidism – ABC CARDIOL

ABCIC

Case Report

Transitory Apical Hypokinesia in Hyperthyroidism

Luis Eduardo da Rocha Silveira

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Anatomopathological Correlation

Case 3/2019 – Young Male with Intense Dyspnea, Pulmonary Infiltrate, Normal Cardiac Area and Obliteration of the Apical Portion of the Left Ventricle

Victor Sarli Issa et al. Luiz Alberto Benvenuti

Clinical aspects

This is the case of a young, male patient, smoker, who had hypothyroidism post-treatment with radioactive iodine, who sought medical care due to symptoms of dyspnea and cough for a week; these complaints had been preceded by chest pain at exertion two weeks before. The medical evaluation at the first consultation was notable for the presence of tachycardia and mild leukocytosis in the whole blood count.

The chest X-ray was normal despite the presence of dyspnea at rest. Interestingly, the ECG performed during a routine medical evaluation 11 months before symptom onset showed signs suggestive of heart disease, with left chamber overload.

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Original Article

Effect of Fetal Hypothyroidism on Cardiac Myosin Heavy Chain Expression in Male Rats

Nasibeh Yousefzadeh et al. Sajad Jeddi Mohammad Reza Alipour

Abstract

Background:

Thyroid hormone deficiency during fetal life could affect the cardiac function in later life. The mechanism underlying this action in fetal hypothyroidism (FH) in rats has not been elucidated thus far.

Objective:

The aim of this study is to evaluation the effect of FH on cardiac function in male rats and to determine the contribution of α-myosin heavy chain (MHC) and β-MHC isoforms.

Methods:

Six pregnant female rats were randomly divided into two groups: The hypothyroid group received water containing 6-propyl-2-thiouracil during gestation and the controls consumed tap water. The offspring of the rats were tested in adulthood. Hearts from the FH and control rats were isolated and perfused with langendroff setup for measuring hemodynamic parameters; also, the heart mRNA expressions of α- MHC and β-MHC were measured by qPCR.

Results:

Baseline LVDP (74.0 ± 3.1 vs. 92.5 ± 3.2 mmHg, p < 0.05) and heart rate (217 ± 11 vs. 273 ± 6 beat/min, p < 0.05) were lower in the FH rats than controls. Also, these results showed the same significance in ±dp/dt. In the FH rats, β-MHC expression was higher (201%) and α- MHC expression was lower (47%) than control.

Conclusion:

Thyroid hormone deficiency during fetal life could attenuate normal cardiac functions in adult rats, an effect at least in part due to the increased expression of β-MHC to α- MHC ratio in the heart.

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Original Article

Effects of Ischemic Postconditioning on the Hemodynamic Parameters and Heart Nitric Oxide Levels of Hypothyroid Rats

Sajad Jeddi et al. Jalal Zaman Asghar Ghasemi

Background:

Ischemic postconditioning (IPost) is a method of protecting the heart against ischemia-reperfusion (IR) injury. However, the effectiveness of IPost in cases of ischemic heart disease accompanied by co-morbidities such as hypothyroidism remains unclear.

Objective:

The aim of this study was to determine the effect of IPost on myocardial IR injury in hypothyroid male rats.

Methods:

Propylthiouracil in drinking water (500 mg/L) was administered to male rats for 21 days to induce hypothyroidism. The hearts from control and hypothyroid rats were perfused in a Langendorff apparatus and exposed to 30 min of global ischemia, followed by 120 min of reperfusion. IPost was induced immediately following ischemia.

Results:

Hypothyroidism and IPost significantly improved the left ventricular developed pressure (LVDP) and peak rates of positive and negative changes in left ventricular pressure (±dp/dt) during reperfusion in control rats (p < 0.05). However, IPost had no add-on effect on the recovery of LVDP and ±dp/dt in hypothyroid rats. Furthermore, hypothyroidism significantly decreased the basal NO metabolite (NO_x) levels of the serum (72.5 ± 4.2 vs. 102.8 ± 3.7 μmol/L; p < 0.05) and heart (7.9 ± 1.6 vs. 18.8 ± 3.2 μmol/L; p < 0.05). Heart NO_x concentration in the hypothyroid groups did not change after IR and IPost, whereas these were significantly (p < 0.05) higher and lower after IR and IPost, respectively, in the control groups.

Conclusion:

Hypothyroidism protects the heart from IR injury, which may be due to a decrease in basal nitric oxide (NO) levels in the serum and heart and a decrease in NO after IR. IPost did not decrease the NO level and did not provide further cardioprotection in the hypothyroid group.

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Artigo Original

Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism

Marcia Martins Ferreira et al. Patricia de Fatima dos Santos Teixeira Vera Aleta R. Mansur Vaneska Spinelli Reuters … Cloyra Paiva Almeida Mario Vaisman

BACKGROUND: Overt hypothyroidism is associated with elevation of diastolic blood pressure; however the association of subclinical hypothyroidism (SH) with arterial blood pressure (ABP) alteration is unknown. OBJECTIVE: The aim of the present study was to evaluate ambulatory blood pressure monitoring (ABPM), over 24 hours, in normotensive patients with SH in comparison to euthyroid (EU) normotensive individuals. METHODS: A cross-sectional study was performed with 50 participants (SH = 30 and EU = 20) that did not differ regarding risk factors for hypertension. The ABPM was carried out with a DINAMAPA TM monitor, using the oscillometric method validated by AAMI (Association for the Advancement of Medical Instrumentation) and by the BHS (British Hypertension Society). RESULTS: The mean serum TSH and FT4 were respectively 6.9 ± 2.2 µUI/ml and 1.1 ± 0.2 ng/dl in SH patients. Although there was no difference in the mean values of systolic and diastolic blood pressure between the two groups, there was a positive correlation between the mean values of diastolic blood pressure (DBP) and serum TSH levels in SH patients (r:0.477; p = 0.004). These correlations were detected at daytime (r:0.498; p = 0.002) and sleep-time (r:0.322; p = 0.032) measurements. CONCLUSION: The blood pressure was not different between patients with or without SH; however, the results suggest that the progression of subclinical hypothyroidism to higher levels of TSH may increase the cardiovascular risk by increasing diastolic blood pressure.

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Anatomopathological Session

Case 6/2008: a 54 year-old male with hemiparesy and seizures since hildhood evolving with heart failure 10 years after precordial pain and normal coronary angiography

Gustavo Freitas Feitosa et al. Ricardo D'Oliveira Vieira Paulo Jorge Moffa Reynaldo Amato … Sérgio Rosemberg Vera Demarchi Aiello

ANATOMOPATHOLOGICAL SESSION

Case 6/2008 – a 54 year-old male with hemiparesy and seizures since hildhood evolving with heart failure 10 years after precordial pain and normal coronary angiography

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Artigo de Pesquisa

Hypolipidemic therapy in special situations: hypothyroidism and liver disease

Fernando H. Y. Cesena et al. Hermes Toros Xavier Protásio L. da Luz

Hypothiroidism is common in the elderly, especially among women. It should be suspected in the presence of classic signals and symptoms, and can be detected by an elevation of serum thyroid stimulating hormone (TSH). Lipid abnormalities in the presence of subclinical hypothiroidsm are of minor importance. However, the importance of specific treatment (hormone replacement) increases with the magnitude of thyroid disturbance. Some hypolipidemic agents can aggravate prior liver disease, however, recent studies have shown that statins might be useful in the presence of steatohepatitis. Some associations of hypolipidemic drugs can increase liver enzymes, and careful monitoring is recommended.

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Artigo Original

Thyroid dysfunction and cardiological management in patients receiving amiodarone

Anna Gabriela Fuks et al. Mário Vaisman Alexandru Buescu

OBJECTIVE: To determine the prevalence of thyroid dysfunction in patients receiving amiodarone, and the possible associated factors. The study also aimed at assessing the effect of amiodarone on thyroid function through the application of a questionnaire to cardiologists. METHOD: Fifty-six patients chronically (> 3 months) receiving amiodarone were assessed by measurement of their serum levels of TSH, free T4, total T3, and anti-TPO antibodies. Patients with changes in TSH levels were defined as having thyroid dysfunction (TD). RESULTS: The prevalence of thyroid dysfunction was 33.9%. No difference was observed between this group and that of patients with no dysfunction, except for the greater prevalence of anti-TPO positivity in patients with TD (P=0.02). Subclinical hypothyroidism was diagnosed in 10 (17.9%) patients and clinical hypothyroidism in 6 (10.7%). The prevalence of subclinical hyperthyroidism was 3.6% and that of clinical hyperthyroidism was 1.8%. Anti-TPO antibodies were positive in 5 (8%) patients (of whom, 4 had thyroid dysfunction). When compared with patients negative for anti-TPO antibodies, that group had a greater prevalence of dysfunction (80% vs 29.4%; P=0.04). Only 49.2% of the cardiologists routinely treated their patients’ thyroid function, and the prevalence of the referred dysfunction for most of them ranged from 1 to 10%. CONCLUSION: The prevalence of thyroid dysfunction in our population was high, showing the need for implementing a laboratory routine. The cardiologists disagreed greatly in regard to the type of follow-up required for patients using amiodarone.

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Original Article

Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients

Ana Valéria Barros de Castro et al. Alexandra Procópio Bononi Flávio Aragon Carlos Roberto Padovani … Célia Regina Nogueira Gláucia M. F. da Silva Mazeto Walkyria de Paula Pimenta

OBJECTIVE: To determine the frequency of hypothyroidism in a sample of hyperlipemic patients and evaluate clinical and laboratory factors indicative of thyropathy among them. METHODS: Fifty-one hyperlipemic patients, grouped according to an earlier or recent diagnosis of their thyroid function into euthyroid and hypothyroid, were evaluated with clinical and laboratory examinations of blood levels of free T4 and TSH (by radioimmunoassay). Patients were on average 46.8±11.7 years old, predominantly of the female sex (62.5%); 31% had a previous diagnosis of hypothyroidism and were under treatment with thyroxin. RESULTS: Fourteen three percent of patients analyzed had hypothyroidism, which had not been detected before. Differentiating attributes of the groups analyzed were: a predominance of females among the hypothyroid patients and a higher HDL serum concentration among those recently diagnosed. CONCLUSION: In the present study, new cases of hypothyroidism in hyperlipemic patients were a frequent occurrence, yet few clinical and laboratory data except tests evaluating free T4 and TSH in the blood indicated which patients had thyroid dysfunction.

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