Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study

Aweimer, Assem; El‐Battrawy, Ibrahim; Akın, İbrahim; Borggrefe, Martin; Mügge, Andreas; Patsalis, Polykarpos; Urban, Aline; Kummer, Marvin; Vasileva, S.V.; Stachon, Axel; Hering, S.; Dietrich, Johannes W.

doi:10.1111/joim.13189

Cited by 38 publications

(28 citation statements)

References 55 publications

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“…For instance, thyroid hormones enable sensitization of the heart for CAs by stimulating β1 receptor expression in cardiomyocytes [18,19]. An excess of thyroid hormones might potentiate the effects of CAs in cardiovascular tissues, leading to increased sensitivity to stress events, which might be involved in the etiology of Takotsubo cardiomyopathy [19]. The results of our study may also indicate the presence of a functional sympatho-adrenergic system in various patients who visit a general medicine department.…”

Section: Discussionmentioning

confidence: 68%

“…The mutual interaction between the levels of urinary CAs and thyroid hormone levels may be involved in some critical disorders. For instance, thyroid hormones enable sensitization of the heart for CAs by stimulating β1 receptor expression in cardiomyocytes [18,19]. An excess of thyroid hormones might potentiate the effects of CAs in cardiovascular tissues, leading to increased sensitivity to stress events, which might be involved in the etiology of Takotsubo cardiomyopathy [19].…”

Section: Discussionmentioning

confidence: 99%

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Clinical utility of urinary levels of catecholamines and their fraction ratios related to heart rate and thyroid function

et al. 2022

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Clinical utility of urinary levels of catecholamines and their fraction ratios related to heart rate and thyroid function

et al. 2022

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“…It is important to note the link between endocrine disorders and the heart. Thyroid hormones have several effects on the cardiovascular system ( 7 – 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note the link between endocrine disorders and the heart. Thyroid hormones have several effects on the cardiovascular system (7)(8)(9). The thyroid secretes two hormones, thyroxine (T4), a prohormone, and triiodothyronine (T3), the active hormone (7).…”

Section: Discussionmentioning

confidence: 99%

Hyperthyroidism With Atrial Fibrillation in Children: A Case Report and Review of the Literature

Subramonian

Amed

et al. 2021

Front. Endocrinol.

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Atrial fibrillation is exceedingly rare in children with structurally and functionally normal hearts. We present a novel case of a 15-year-old female with known hyperthyroidism who subsequently developed atrial fibrillation. She had been suffering from fatigue, heat intolerance and myalgias for 6 months. Her initial TSH was 0.01mU/L, and free T4 was 75.4 pmol/L, with a free T3 of >30.8 pmol/L. An electrocardiogram showed atrial fibrillation with a ventricular rate of 141 beats per minute. An echocardiogram demonstrated an enlarged left atrium and ventricle, with mild mitral regurgitation. She was treated with methimazole and underwent synchronized cardioversion. She subsequently returned to a euthyroid state and remained in normal sinus rhythm. In this case, we discuss the physiologic and arrhythmogenic properties of thyroid hormone, with a summary of the existing literature on atrial fibrillation in hyperthyroidism in children. Current guidelines for treatment of atrial fibrillation are also outlined.

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“…Published data suggest an association between thyroid hormone concentrations and the risk of sudden cardiac death (SCD) even in euthyroid populations with high-normal FT4 concentration (9). Recently, similar relations between thyroid function and the incidence of other endpoints, including malignant arrhythmia and stress cardiomyopathy (Takotsubo syndrome), have been described (10,11). However, the electrophysiological mechanisms underlying these observations are poorly understood up to now.…”

Section: Introductionmentioning

confidence: 98%

Abnormal Cardiac Repolarization in Thyroid Diseases: Results of an Observational Study

Aweimer

Schiedat²,

Schöne³

et al. 2021

Front. Cardiovasc. Med.

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Background: The relationship between thyroid function and cardiac disease is complex. Both hypothyroidism and thyrotoxicosis can predispose to ventricular arrhythmia and other major adverse cardiovascular events (MACE), so that a U-shaped relationship between thyroid signaling and the incidence of MACE has been postulated. Moreover, recently published data suggest an association between thyroid hormone concentration and the risk of sudden cardiac death (SCD) even in euthyroid populations with high-normal FT4 levels. In this study, we investigated markers of repolarization in ECGs, as predictors of cardiovascular events, in patients with a spectrum of subclinical and overt thyroid dysfunction.Methods: Resting ECGs of 100 subjects, 90 patients (LV-EF > 45%) with thyroid disease (60 overt hyperthyroid, 11 overt hypothyroid and 19 L-T4-treated and biochemically euthyroid patients after thyroidectomy or with autoimmune thyroiditis) and 10 healthy volunteers were analyzed for Tp-e interval. The Tp-e interval was measured manually and was correlated to serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and thyroxine (FT4).Results: The Tp-e interval significantly correlated to log-transformed concentrations of TSH (Spearman's rho = 0.30, p < 0.01), FT4 (rho = −0.26, p < 0.05), and FT3 (rho = −0.23, p < 0.05) as well as log-transformed thyroid's secretory capacity (SPINA-GT, rho = −0.33, p < 0.01). Spearman's rho of correlations of JT interval to log-transformed TSH, FT4, FT3, and SPINA-GT were 0.51 (p < 1e−7), −0.45 (p < 1e−5), −0.55 (p < 1e−8), and −0.43 (p < 1e−4), respectively. In minimal multivariable regression models, markers of thyroid homeostasis correlated to heart rate, QT, Tp-e, and JT intervals. Group-wise evaluation in hypothyroid, euthyroid and hyperthyroid subjects revealed similar correlations in all three groups.Conclusion: We observed significant inverse correlations of Tp-e and JT intervals with FT4 and FT3 over the whole spectrum of thyroid function. Our data suggest a possible mechanism of SCD in hypothyroid state by prolongation of repolarization. We do not observe a U-shaped relationship, so that the mechanism of SCD in patients with high FT4 or hyperthyroidism seems not to be driven by abnormalities in repolarization.

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Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study

Abstract: Germany). Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study.

Cited by 38 publications

References 55 publications

Clinical utility of urinary levels of catecholamines and their fraction ratios related to heart rate and thyroid function

Clinical utility of urinary levels of catecholamines and their fraction ratios related to heart rate and thyroid function

Hyperthyroidism With Atrial Fibrillation in Children: A Case Report and Review of the Literature

Abnormal Cardiac Repolarization in Thyroid Diseases: Results of an Observational Study

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