A Cross-Sectional Study of Acute Coronary Syndrome and Thyroid Profile: Dissecting the Relationship to Improve Patient Care

Abstract

Introduction: Thyroid-releasing hormones are pivotal in regulating cardiovascular (CVS) function and maintaining its hemodynamics and homeostasis. Even a minor alteration in thyroid function has an enormous implication on CVS morbidity and mortality. Moreover, hypothyroidism was found to be a potential menace for coronary artery disease (CAD). The objective of this study was to determine the role of thyroid-releasing hormones in patients suffering from acute coronary syndrome (ACS). Methodology: Among a cohort of 100 patients suffering with ACS, a complete history and clinical information followed by physical examination and electrocardiography were recorded. Blood samples were also collected to record the blood sugar levels i.e., fasting blood sugar (FBS), postprandial blood sugar (PPBS), and thyroid profile, including free thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and reverse triiodothyronine (rT3). The data was analyzed using SPSS version 26 software (IBM Corp., Armonk, NY, USA). Result: The study identified alterations in the thyroid hormone levels in 27% of patients suffering from ACS. The prevalence of euthyroid sick syndrome was found to be 59.3%, while subclinical hypothyroidism and subclinical hyperthyroidism were reported among 18.5% and 14.8% of patients respectively. There was no significant difference found between males and females. The study illustrated a greater occurrence of aberrant thyroid hormone profiles among those aged 40-60 years. The ST-elevated myocardial infarction (STEMI) group had a statistically significant higher prevalence of an aberrant thyroid hormone profile compared to the non-ST-elevated myocardial infarction (NSTEMI) and unstable angina (UA) groups (p=0.02). A total of nine patients died with ACS and all of those had statistically significant low fT3 and TSH values while higher rT3 values (p<0.05). Conclusion: An atypical thyroid status has been found to elevate the likelihood of developing CAD and experiencing CVS mortality. This condition can impact ventricular function and serum cholesterol levels as well as heart rate and rhythm. Therefore, understanding this relationship could potentially lead to improved treatment strategies for individuals with ACS which will further prevent major CVS complications.

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

“…A similar conclusion was reached by Lamprou et al [ 17 ]. While some studies conclude that TSH levels and thyroid status have no impact on ACS outcomes [ 18 ], there is a body of growing evidence that thyroid pathology exacerbates ACS outcomes [ 19 , 20 ]. Atypical thyroid status worsens ventricular function, elevates cholesterol levels, and impacts heart rate and rhythm; thus, it might deteriorate the prognosis of an ACS event [ 20 ].…”

“…While some studies conclude that TSH levels and thyroid status have no impact on ACS outcomes [ 18 ], there is a body of growing evidence that thyroid pathology exacerbates ACS outcomes [ 19 , 20 ]. Atypical thyroid status worsens ventricular function, elevates cholesterol levels, and impacts heart rate and rhythm; thus, it might deteriorate the prognosis of an ACS event [ 20 ]. Hyperthyroidism affects the rate and prognosis of ACS primarily by worsening ventricular function, inducing tachyarrhythmias and provoking vasospasm [ 20 ].…”

“…Atypical thyroid status worsens ventricular function, elevates cholesterol levels, and impacts heart rate and rhythm; thus, it might deteriorate the prognosis of an ACS event [ 20 ]. Hyperthyroidism affects the rate and prognosis of ACS primarily by worsening ventricular function, inducing tachyarrhythmias and provoking vasospasm [ 20 ]. Hypothyroidism is associated with hypercholesterolemia, thereby increasing the likelihood of coronary heart disease and ACS [ 21 , 22 ].…”