Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction

Su, Wen; Zhao, Xiaohui; Wang, Man; Chen, Hui; Li, Hongwei

doi:10.1016/j.jjcc.2018.02.013

Cited by 36 publications

(37 citation statements)

References 26 publications

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“…In hospitalized patients with acute heart failure, low FT3 was associated with longer hospital stay and increased ICU admission rate. Low T3 was also a predictor of in-hospital cardiovascular death in patients with acute myocardial infarction [ 4 ] and all-cause mortality in patients with chronic renal failure [ 3 ]. In patients with acute-on-chronic liver failure, reduced TSH, rather than low T3 or low T4, was an independent predictor of death [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Decreased serum triiodothyronine (T3) concentration in euthyroid patients, which is termed nonthyroidal illness (NTIS) or euthyroid sick syndrome, is frequently present in critically ill patients. Reduced T3 concentration has been related to mortality in patients with chronic renal failure (CRF) [ 3 ], acute myocardial infarction [ 4 ], and surgical sepsis [ 5 ]. Other studies showed that decreased TSH concentration was an independent predictor of mortality in patients with acute-on-chronic liver failure [ 6 ] or elderly people in community [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Thyroid hormone concentrations in severely or critically ill patients with COVID-19

Gao

Guo

et al. 2020

J Endocrinol Invest

100

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Objective COVID-19 is a new coronavirus infectious disease. We aimed to study the characteristics of thyroid hormone levels in patients with COVID-19 and to explore whether thyroid hormone predicts all-cause mortality of severely or critically ill patients. Methods The clinical data of 100 patients with COVID-19, who were admitted to Wuhan Tongji Hospital from February 8 to March 8, 2020, were analyzed in this retrospective study. The patients were followed up for 6–41 days. Patients were grouped into non-severe illness and severe or critical illness, which included survivors and non-survivors. Multivariate Cox proportional hazards analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in association with continuous and the lower two quartiles of thyroid hormone concentrations in severely or critically ill patients. Results The means of free T3 (FT3) were 4.40, 3.73 and 2.76 pmol/L in non-severely ill patients, survivors and non-survivors, respectively. The lower (versus upper) two quartiles of FT3 was associated with all-cause mortality HR (95% CI) of 9.23 (2.01, 42.28). The HR (95% CI) for all-cause mortality in association with continuous FT3 concentration was 0.41 (0.21, 0.81). In the multivariate-adjusted models, free T4 (FT4), TSH and FT3/FT4 were not significantly related to all-cause mortality. Patients with FT3 less than 3.10 pmol/L had increased all-cause mortality. Conclusion FT3 concentration was significantly lower in patients with severe COVID-19 than in non-severely ill patients. Reduced FT3 independently predicted all-cause mortality of patients with severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thyroid hormone concentrations in severely or critically ill patients with COVID-19

Gao

Guo

et al. 2020

J Endocrinol Invest

100

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“…Euthyroid sick syndrome (ESS), also known as non-thyroidal illness syndrome, is a transient derangement in thyroid function tests characterized by low T3 levels. ESS is reportedly associated with a higher risk of fatality among critically ill patients admitted with myocardial infarction, sepsis, trauma, and chronic kidney disease [4][5][6][7]. In addition, ICU patients with ESS tend to experience more severe symptoms compared to those with normal thyroid function [8].…”

Section: Introductionmentioning

confidence: 99%

Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

Shao

Guo

et al. 2020

Preprint

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Background: Euthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children suffering from DKA/DK.Methods: 98 DKA and 96 DK pediatric patients were selected from hospital records. Those on thyroxine replacement, with overt hypothyroidism, or with positive anti-thyroperoxidase (TPO) antibody were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done on all patients. Children were divided into euthyroid (n=88) and ESS groups (n=106).Results: The ESS group had a higher level of white blood cell count (WBC), plasma glucose (PG), beta-hydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), glycosylated hemoglobin (HbA1c) and a lower level of HCO3-, prealbumin (PA), and albumin (ALB) compared with the euthyroid group (P<0.05). Free T3 (FT3) levels were significantly correlated to β-HB, HCO3-, AG, PA, and HbA1c (r=-0.642, 0.681, -0.377, 0.581, -0.309, respectively; P<0.01). Free T4 (FT4) levels were significantly correlated to β-HB, HCO3-, and ALB levels (r=-0.489, 0.338, 0.529, respectively; P<0.01). TSH levels were significantly affected by HCO3– only (r=-0.28; P<0.01). HCO3– level was the most important factor deciding euthyroid or ESS on logistic regression analysis (OR=0.844, P=0.004, 95%CI=0.751-0.948).Conclusions: Lower levels of free thyroid hormones and occurrence of ESS were associated with a higher degree of acidosis in children with DKA/DK.

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“…The physiological relationship between the cardiovascular system and thyroid function has led to multiple observational studies evaluating the association between hypothyroidism and cardiovascular disease, which have described higher risk of cardiovascular events and mortality in patients with hypothyroidism as compared to those who were euthyroid [4,5]. Low triiodothyronine (T3) has been identified as a prognostic factor for patients with acute myocardial infarction (AMI) associated with increased biomarkers of cardiac injury, decreased left ventricular function, and increased mortality [6,7].…”

Section: Introductionmentioning

confidence: 99%

Management of Hypothyroidism in Patients with Acute Myocardial Infarction

et al. 2020

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Background and Objectives: Thyroid hormones (TH) affect cardiac function through effects on cardiac contractility and systemic vascular resistance. While TH replacement for patients with hypothyroidism might be necessary for restoration of cardiac output after an acute myocardial infarction (AMI), it could theoretically lead to excessively rapid restoration of the metabolic rate. The appropriate management of hypothyroidism in patients with AMI is unknown. We describe the practice patterns in the management of hypothyroidism in the setting of AMI as well as patients’ clinical outcomes. Material and Methods: Retrospective study of patients that were admitted to a tertiary care hospital with AMI and newly diagnosed or uncontrolled hypothyroidism (TSH ≥ 10 mIU/L) between 2011–2018. Eligible patients were identified using diagnosis codes for AMI and laboratory values, followed by medical record review. We categorized patients according to treatment status with TH and by degree of hypothyroidism. Clinical outcomes included: 30-day mortality/readmission, bleeding, stroke, arrhythmia, sudden cardiac death, and new or worsening heart failure. Summary statistics and group comparisons are presented. Results: Sixty-four patients were included, their median age was 64 years and 61% (n = 39) were women. Most of the patients (59%) had a documented history of hypothyroidism. Of these, all were restarted on levothyroxine (LT4) during the index admission when compared to patients without a history of hypothyroidism, of which 54% received LT4 treatment (p = 0.001). The median TSH in those treated with LT4 was higher (25 mIU/L) when compared to those who were not (12 mIU/L), (p = 0.007). Patients who received intravenous LT4 had higher TSH levels and other variables suggesting worse clinical presentation, but these differences were not statistically significant. No statistically significant differences were noted on clinical outcomes according to LT4 treatment status. Conclusion: A history of hypothyroidism and the degree of TSH elevation seem to guide the management of hypothyroidism in patients with AMI. The clinical effect of correcting hypothyroidism in this setting requires further evaluation.

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Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction

Abstract: LT3S was associated with more severe myocardial injury and increased in-hospital CV mortality in patients with AMI. Furthermore, it improved risk prediction of in-hospital CV death post-AMI when it was added to the TIMI risk score.

Cited by 36 publications

References 26 publications

Thyroid hormone concentrations in severely or critically ill patients with COVID-19

Thyroid hormone concentrations in severely or critically ill patients with COVID-19

Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

Management of Hypothyroidism in Patients with Acute Myocardial Infarction

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