Abstract
Context: Thyroid disorders (hypothyroidism and hyperthyroidism) are associated with clinically significant cardiovascular changes. In the present study, patients with various types of thyroid disorders examined clinically and biochemically. Their cardiovascular status assessed by electrocardiography, radiologically and echocardiographically, and compared with controls with an aim to determine the effect of thyroid disease on the cardiac status.
Methods and Material: This is a case control study, conducted at a tertiary care centre for two years. This study included 80 cases, comprised of 40 cases of hyperthyroidism and 40 cases of hypothyroidism. 40 healthy age and sex matched subjects were also included in the study as a control for comparison.
Statistical analysis used: Pearson’s Chi-Square test was used for qualitative data to observe the association of the thyroid diseases with cardiovascular abnormalities in hyperthyroid, hypothyroid patients and controls subjects.
Results: Among hyperthyroid patients, sinus tachycardia was the predominant ECG abnormality while, sinus bradycardia was the most common findings among hypothyroid cases. Diastolic dysfunction was seen in 10% of hyperthyroid subjects and 5% of hypothyroid subjects. Systolic dysfunction was seen in 14% of hyperthyroid subjects and 17% of hypothyroid subjects. Interventricular septum thickness was increased in 17.5% of hypothyroid cases in our study. Serum cholesterol and triglycerides levels were significantly higher in hypothyroidism subjects.
Conclusions: The cardiovascular signs and symptoms of thyroid disease are some of the most profound and clinically relevant findings that accompany both hyperthyroidism and hypothyroidism. Echocardiography is a very valuable tool in evaluation of the effects of hypothyroidism on heart and can detect earliest changes.
Key-words: Hypothyroidism, hyperthyroidism, echocardiography.
References
1. Shashikanth M. Study of cardiac dysfuction in hypothyroidism. Indian Journal of Basic and Applied Medical Research 2015;4:111-6.
2. Karki P, Pandey I, Bhandary S, Lamsal M, Nikesh, Shrestha R, et al. An Echocardiographic Evaluation of Diastolic Dysfunction in Patients with Subclinical Hypothyroidism & the effect of L-Thyroxine treatment: A hospital based study. Nepalese Heart Journal 2014;11(1): 33-38.
3. Malenkovic V, Paunovic I. Cardiovascular manifestations of hyperthyroidism: Clinical significance and preoperative preparation. Srp Arh Celok 2000;128:379-83.
4. Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007;116:1725.
5. Simon HS, Pearce GB, Leonidas HD, Monzani F, Robin P, Razvi S, et al. ETA Guideline 2013: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013;2:215.
6. Gerdes AM, Iervasi G. Contemporary Reviews in Cardiovascular Medicine: Thyroid Replacement Therapy and Heart Failure. Circulation 2010;122:385-93.
7. Nixon JV, Anderson RJ, Cohen ML. Alternation in left ventricular mass and performance in patients treated effectively for thyrotoxicosis. Am J Med 1970; 67:268-76.
8. Watanakunakorn C, Hodges RE, Evans TC. Myxedema; a study of 400 cases. Arch Intern Med 1965;116:183–90.
9. Kerber RE, Sherman B. Echocardiographic evaluation of pericardial effusion in myxedema. Circulation 1975;52:823-7.
10. Kahaly GJ, Nieswandt J, Mohr-Kahaly S. Cardiac risks of hyperthyroidism in the elderly. Thyroid 1998;8:1165.
11. Northcote RJ, MacFarlane P, Kesson CM, Ballantyne D. Continuous 24-hour electrocardiography in thyrotoxicosis before and after treatment. Am Heart J 1986;112:339–43.
12. Ramesh K, Nayak BS. A study of cardiovascular involvement in Hypothyroidism. IAIM, 2016;3:74-80.
13. Verma R, Jain AK, Ghose T. Heart in hypothyroidism - an echocardiographic study. JAPI. 1996;44:390–2.
14. Forfar JC, Muri AL, Sawers SA, Toft AD. Abnormal left ventricular function in hyperthyroidism: evidence for a possible reversible cardiomyopathy. N Engl J Med 1982;307:1165-1170.
15. Smallridge RC, Goldman MH, Raines K, Nostrand JS. Rest and exercise left ventricular function in hypothyroidism. Am J Cardiol. 1987;60:929-31.
16. Yamada H, Goh PP, Sun JP, Odabashian J, Garcia MJ, Thomas JD, et al. Prevalence of Left Ventricular Diastolic Dysfunction by Doppler Echocardiography: Clinical applications of the Canadian Consensus Guidelines. J Am Soc Echocardiography 2002;15:1238-44.
17. Rawat B, Satyal A. An echocardiographic study of cardiac changes in hypothyroidism and the response to treatment. Kathmandu University Medical Journal. 2003;2:182-7.
18. Bello V, Monzani F, Giorgi D, Bertini A, Caraccio N, Valenti G, et al. Ultrasonic myocardial textural analysis in subclinical hypothyroidism. J Am Soc Echocardiogr 2000;13:832-40.
19. Monzani F, Di Bello V, Caraccio N, Bertini A, Giorgi D, Giusti C, et al. Effect of levothyroxine on cardiac function and structure in sub clinical hypothyroidism: a double blind, placebo-controlled study. J Clin Endocrinol Metab 2001;86:1110-5.
20. Yazbeck R, Benoit P, Roche B, Boeglin MB, Tauveron I, Thieblot P. Primary hypothyroidism in the adult older than 60 years. Characteristics and follow up after initiations of replacement treatment. Presse Med 2001;30:1193-8.
21. Gupta A, Sinha RS. Echocardiographic changes and alterations in lipid profile in cases of subclinical and overt hypothyroidism. JAPI 1996;44:551–3.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.180
