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Category: Volume 05 Issue 08 August 2017
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Title: Echocardiographic evaluation of cardiac function in hypothyroidism

Authors: Dr Sunita D. Kumbhalkar, Dr Shakti P. Choudhury

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.201

Abstract

Aim and Objectives: To study the clinical profile and various echocardiographic changes in hypothyroid patients and compare these changes between hypothyroid patients and controls.

Methods: We included 32 consecutive first time detected hypothyroid patients diagnosed through thyroid profile and 15 healthy age and sex matched controls. The clinical electrocardiographic and echocardiographic features of the study group were compared to their respective age and sex matched healthy controls.

Results: In current study, most of the patients (56.25%) had presented with pre-hypertension stage. Hypothyroid patients had significantly raise TSH and low T3 and T4 and also had raised serum cholesterol, triglyceride and LDL concentration as compared to controls. The sinus bradycardia was commonest electrocardiogram abnormality being present in 43.75% patients followed by low voltage complexes (18.75%), ST-T changes (15.62%) and right bundle branch block (3.1%) while 18.75% had normal electrocardiogram. There was no statistical difference in basic two dimensional echocardiographic parameters between two groups. We found significant reduction in early diastolic filling (E) with augmented late diastolic filling (A) resulting in decrease E/A ratio suggesting significant diastolic dysfunction associated with significant reduction in, peak early diastolic velocity (E’), raised peak late velocity (A’) and increased E/E’ in both overt and subclinical hypothyroid patients. IVRT and DT were also prolonged. Increased interventricular septal and posterior wall thickness was also found in overt hypothyroid along with pericardial effusion when compared to subclinical and controls. There was no significant difference observed in ejection fraction and systolic velocity between two groups.

Conclusion: This study demonstrated that diastolic function was impaired in patients with hypothyroidism. Doppler-echocardiography may be considered a reliable method for a cross-sectional and longitudinal assessment of left ventricular diastolic function in patients with hypothyroidism. 

Keywords: Electrocardiography; Doppler-Echocardiography; Hypothyroidism; Diastolic filling; Systolic velocity, Interventricular septal.

References

  1. Stiefelhagen P. Cardiac symptoms in endocrinologic disorders. Heart illness caused by the thyroid gland. MMW. Fortschr. Med. 2009; 151(19):12-13.
  2. Brutsaert DL, Sys SU, Gilleberi TC. Diastolic failure: Pathophysiology and therapeutic implications. J Am Coll Cardiol 1993;22:318-125.
  3. Klein I, Ojama K. Thyroid hormone and cardiovascular system. N Engl J Med 2001;344:501-509.
  4. Rodondi N, Bauer DC, Cappola AR. Subclinical thyroid dysfunction, cardiac fuction and the risk of heart faire. The cardiovascular Health study. J Am. Coll. Cardiol 2008;52(14):1152-1159.
  5. Biondi B, Fazio S, Palmieri EA. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J. Clin Endocrinol Metab 1999;84:2064-2067.
  6. Mishra TK, Routray SN, Das S, Behera M. Left ventricular dysfunction in patients with subclinical hypothyroidism and its reversibility after hormone therapy 2005;53:943-946.
  7. Meena CL, Meena RD, Nawal R, Meena VK, Bharti A , Meena LP. Assessment of left ventricular diastolic dysfunction in subclinical hypothyroidism. Acta Inform Med 2012;20(4):218-220.
  8. Rawat B, Satyal A. An echocardiographic study of cardiac changes in hypothyroidism and the response to treatment. Kathmandu Univ Med J 2003;2(3):182-187.
  9. Saito I, lto K, Saruta T, Hypothyroidism as a cause of hypertension. Hypertension 1983;5(1):112-115.
  10. Fommei E, Lervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short term hypothyroidism in human . J. Chin. Endocrinol. Metab 2002;87:1996-2000.
  11. Kotsis V, Alevizaki M, Stabouli S. Hypertension and hypothyroidism: results from an ambulatory blood pressure monitoring study. J Hypertens 2007;25:993-999.
  12. William J, Hueston MD, William S, Pearson MHA. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2004;2(4):351-355.
  13. Gupta A, Sinha RS. Echocardiographic changes and alterations in lipid profile in cases of subclinical and overt hypothyroidism. J Assoc Physiciar S India 1996;44(8):546,551-553.
  14. Canaries GJ. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160(4):526-534.
  15. Al-Farttoosi. Cardiovascular manifestations of primary hypothyroidism. The Iraqi postgraduate medical jpurnal 2010;9(2):113-119.
  16. Electrocardiographic changes in patients with hypothyroidism. Endocrine Abstracts 2004;7:246.
  17. Varma R, Jain AK, Ghose T. Heart in hypothyroidism-an echocardiographic study. J Assoc Physicians India 1996;44(6):390-392.
  18. Galderisi M, Vitale G, D’Errico A et al. Usefulness of pulsed tissue Doppler for the assessment of left ventricular myocardial function in overt hypothyroidism, Ital Heart J 2004;5(4):257-264.
  19. Gulbanu Erkan, Aycan Fahri Erkan, Atiya Cengel. The evaluation of diastolic dysfunction with tissue Doppler echocardiography in women with subclinical hypothyroidism and the effect of L-Thyroxine treatment on diastolic dysfunction: A pilot study. J Thyroid Res 2011.2011;654304.
  20. Fatma Alibaz Oner, Selen Yurdakul, Ender Oner et al. Evaluation of ventricular function using tissue Doppler echocardiography in patients with subclinical hypothyroidism. Turk Kardiyol Dern Ars-Arch Turk Soc Cardiol 2011;39:129-136.
  21. Xin Chen, Na Zhang, Yunfei  Cai, Jingpu Shi.  Evaluation of left ventricular diastolic function using tissue Doppler echocardiography and conventional Doppler echocardiography in patients with subclinical hypothyroidism age ˂60 years: A meta-analysis. Journal of Cardiology 2013;61(1):8-15.

Corresponding Author

Dr Sunita Kumbhalkar*

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