Objective: A number of different hormone changes have been described during the acute myocardial infarction (AMI), including those of the non-thyroidal illness syndrome (NTIS).
Design and methods:We assessed the alterations of serum thyroid hormones, cytokines and cortisol levels in 30 patients with a first episode of AMI 4, 24, 48 h and 10 days (240 h) after the onset of the chest pain and we investigated the possible relationship of these alterations with the severity of AMI. Results: Fifteen patients had left ventricular ejection fraction (LVEF) Յ 50% (group I) and 15 patients had LVEF > 50% (group II). A transient decrease of total tri-iodothyronine (T 3 ), more prominent in group I (P < 0.05, t-test) with a concomitant rise of reverse T 3 (rT 3 ) occurred at 24 h. Total thyroxine (T 4 ), free T 4 (FT 4 ) and free T 4 index did not change significantly, but tended to be higher in group I patients, whereas TSH significantly increased in group II at 48 h. Interleukin-6 (IL-6) increased significantly at 24 h only in group I and declined thereafter (24 vs 240 h, P < 0.001) and this temporal change of IL-6 was associated with similar changes of creatine phosphokinase and creatine kinase isoenzyme MB (CK-MB). Tumor necrosis factor-a and IL-1b remained low in both groups. Cortisol was higher at 4 h and in 12 patients was above the normal values. Negative correlation was found between LVEF and IL-6 (P < 0.001), whereas T 3 , T 4 or cortisol levels were not correlated with the LVEF. Conclusions: Our data indicate that NTIS, in association with increase of IL-6, occurs in the early postinfarction period. In the NTIS following AMI the high level of IL-6 is the best predictor, among several parameters, of the severity of AMI as assessed by the LVEF and the rise of CK-MB.
Thyrotropin receptors are expressed in several extrathyroidal tissues including bone. We investigated whether the increase of thyroid-stimulating hormone (TSH) levels, under stable thyroid hormone levels, affects the bone markers. Thirty-two postmenopausal women, with papillary thyroid carcinoma, previously treated with near-total thyroidectomy and I131 remnant ablation underwent routine evaluation for residual disease by using injections of recombinant human TSH (rhTSH) without withdrawal from thyroxine therapy. Changes in TSH levels and various serum and urine markers of bone metabolism were followed before and 1, 2, 5, and 7 days after the rhTSH injections. A transient, significant decrease in serum calcium and urinary excretion of C- and N-terminal telopeptides of type I collagen was observed after the injections of rhTSH. Serum parathyroid hormone (PTH) started to rise along with TSH, but a significant increase of PTH was only reached on Day 5 when the TSH concentration had fallen more than 80% of the peak value. Bone alkaline phosphatase and osteocalcin did not show any significant change over time. There was no significant correlation between TSH concentration and the various parameters we measured. The study provides evidence that rhTSH produces a transient inhibition of bone resorption, as well as an attenuation of osteoblast response in spite of the PTH activation. Additional studies are needed to resolve the mechanisms by which TSH alters the response of the bone cells.
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