Thyroid Hormones and Electrocardiographic Parameters: Findings from the Third National Health and Nutrition Examination Survey

Zhang, Yiyi; Post, Wendy S.; Cheng, Alan; Blasco-Colmenares, Elena; Tomaselli, Gordon F.; Güallar, Eliseo

doi:10.1371/journal.pone.0059489

Cited by 19 publications

(24 citation statements)

References 30 publications

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“…Thyroid hormone exerts both electrophysiological and ionotropic effects on the heart and may increase the risk of developing atherosclerosis [2]. Patients with hyperthyroidism can develop atrial arrhythmias such as sinus tachycardia, atrial flutter, atrial fibrillation, both prolonged and shortened QT interval [2]. It is also linked with angina, rarely myocardial infarction and sudden death [3].…”

Section: Introductionmentioning

confidence: 99%

ECG changes in patients with primary hyperthyroidism

Baladi¹,

Aslam²,

Ahmed³

2018

Pan Afr Med J

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IntroductionThyroid hormones plays key role in regulating cardiovascular system. Its imbalance leads to various electrophysiological changes in cardiovascular system. This study was done to determine the frequency of electrocardiographic (ECG) changes in patients with primary hyperthyroidism.MethodsIt was a descriptive cross-sectional study conducted in the Department of Medicine, Medical Unit III, Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from October 2013 to April 2014. A total of 103 patients newly diagnosed with primary hyperthyroidism were included in this study. Venous blood samples were collected for T3, T3, TSH analyzed by radioimmunoassay. ECG was performed. Outcome variables were the ECG changes i.e. sinus tachycardia and atrial fibrillation.ResultsThe average age of the patients was 30.09±5.57 years (95%CI: 29 to 31.18). Out of 103 cases, 19 (18.45%) were male and 84 (81.55%) were female. Sinus tachycardia was observed in 60.19% (62/103) patients whereas atrial fibrillation was found in 11.65 (12/103) of cases.ConclusionIn this study frequency of electrocardiographic changes in term of sinus tachycardia was high. This report has emphasized the importance of thyrotoxicosis as a cause of cardiac morbidity and mortality in patients with thyrotoxicosis. These cardiac complications are readily reversible if timely optimal treatment is offered.

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Section: Introductionmentioning

confidence: 99%

ECG changes in patients with primary hyperthyroidism

Baladi¹,

Aslam²,

Ahmed³

2018

Pan Afr Med J

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“…It is estimated that more than 12% of the US population will develop a thyroid condition during their lifetime, and an estimated 20 million Americans have already some form of thyroid disease [1] . Besides, some of the most prominent and common symptoms of thyroid disease are those that result from the effects of thyroid hormone on the heart and cardiovascular system [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . Both hyperthyroidism and hypothyroidism produce changes in cardiac contractility, myocardial oxygen consumption, cardiac output, blood pressure, and systemic vascular resistance [12] , [13] , [14] , [15] , [16] , [17] .…”

Section: Introductionmentioning

confidence: 99%

Hypothyroidism and Its Rapid Correction Alter Cardiac Remodeling

Hajje

Saliba

Itani³

et al. 2014

PLoS ONE

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The cardiovascular effects of mild and overt thyroid disease include a vast array of pathological changes. As well, thyroid replacement therapy has been suggested for preserving cardiac function. However, the influence of thyroid hormones on cardiac remodeling has not been thoroughly investigated at the molecular and cellular levels. The purpose of this paper is to study the effect of hypothyroidism and thyroid replacement therapy on cardiac alterations. Thirty Wistar rats were divided into 2 groups: a control (n = 10) group and a group treated with 6-propyl-2-thiouracil (PTU) (n = 20) to induce hypothyroidism. Ten of the 20 rats in the PTU group were then treated with L-thyroxine to quickly re-establish euthyroidism. The serum levels of inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL6) and pro-fibrotic transforming growth factor beta 1 (TGF-β1), were significantly increased in hypothyroid rats; elevations in cardiac stress markers, brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) were also noted. The expressions of cardiac remodeling genes were induced in hypothyroid rats in parallel with the development of fibrosis, and a decline in cardiac function with chamber dilation was measured by echocardiography. Rapidly reversing the hypothyroidism and restoring the euthyroid state improved cardiac function with a decrease in the levels of cardiac remodeling markers. However, this change further increased the levels of inflammatory and fibrotic markers in the plasma and heart and led to myocardial cellular infiltration. In conclusion, we showed that hypothyroidism is related to cardiac function decline, fibrosis and inflammation; most importantly, the rapid correction of hypothyroidism led to cardiac injuries. Our results might offer new insights for the management of hypothyroidism-induced heart disease.

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“…They concluded that these changes might be related with increased risk of arrhythmias [6]. A recent paper also reported prolonged QT intervals in the NHANES (National Health and Nutrition Examination Survey) population with low normal thyroid hormone levels [7]. Kweon et al studied the effects of levothyroxine supplementation on QT interval and QT dispersion in hypothyroid patients and found that levothyroxine therapy significantly decreased the QT intervals and QT dispersion [8].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Cardiac Arrhythmias in Hypothyroid and Euthyroid Patients

2017

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The thyroid functions as a regulator of cardiac function and rhythm through genomic and nongenomic actions of triiodothyronine (T3) in cardiac myocytes. Atrial fibrillation is a common complication of thyrotoxicosis. Hypothyroidism is not considered a risk factor for arrhythmias despite well-known EKG changes in this condition. This case control study was conducted to analyze the differences, if any, in the prevalence of cardiac arrhythmias between hypothyroid patients and euthyroid controls. Three hundred and four consecutive patients admitted at our medical center for a period of one year were included in the study. The study population was divided into 2 groups (age, gender and race matched): patients with hypothyroidism and euthyroid subjects as a control group. Major arrhythmia data were obtained from telemetry recordings and from known past medical history. There were 152 subjects in each arm of the study. The mean age was 61.9 years. Mean TSH in hypothyroid group was 40.4 mIU/l (95% CI 33.3-47.5) (range 10.09-304, SE 3.62) and in euthyroid group was 0.89 mIU/l (95% CI 0.82-0.96). Chi-square analysis revealed a higher prevalence of ventricular tachycardia (p=0.04) and any ventricular arrhythmia in the hypothyroid group (p=0.007). This relatively large case control study revealed a statistically higher prevalence of ventricular arrhythmias in hypothyroidism. Our study has thrown light on the prevalence of arrhythmias in hypothyroidism and the observation of increased ventricular arrhythmias necessitates future large scale prospective studies to better define the risk of such ventricular arrhythmias and the effects of thyroid supplementation on this risk.

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Thyroid Hormones and Electrocardiographic Parameters: Findings from the Third National Health and Nutrition Examination Survey

Cited by 19 publications

References 30 publications

ECG changes in patients with primary hyperthyroidism

ECG changes in patients with primary hyperthyroidism

Hypothyroidism and Its Rapid Correction Alter Cardiac Remodeling

Prevalence of Cardiac Arrhythmias in Hypothyroid and Euthyroid Patients

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