Free Triiodothyronine Levels and Short-Term Prognosis in Chronic Heart Failure Patients With Type 2 Diabetes

Chen, Pingan; Li, Shaonan; Li, Xiaoming; Liu, Zhen; Luo, Yi; Wu, Daihong; Xu, Dingli

doi:10.1097/maj.0000000000000524

Cited by 17 publications

(15 citation statements)

References 37 publications

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“…However, in the course of renal failure but without overt hypothyroidism, low T3 levels may cause RAS system inhibition and / or may lead to differences in receptor levels and this process may increase the risk of hyperkalemia. In many studies, low levels of FT3 is associated with hypervolemia and this could secondarily inhibit RAS system which would eventually lead to hyperkalemia (22)(23)(24). In our study, we found significant correlation between FT3 levels and hypertension, particularly systolic blood pressure elevation.…”

Section: Discussionsupporting

confidence: 66%

The Effect of Low FT3 Level on Kidney Disease Progression and Potassium Levels in Euthyroid Adult Patients with Solitary Kidney

Tatar¹,

Uslu²,

Atakaya³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE: The aim of this study was to investigate the effect of low FT3 levels on CKD progression and hyperkalemia in euthyroid patients with solitary kidney. MATERIAL and METHODS:Seventy-six solitary kidney outpatients were enrolled in the study. Patients with a preexisting thyroid disease were excluded. The baseline and final laboratory parameters were evaluated. Serum Thyroid hormones (TSH, FT3 and FT4) were measured at baseline. RESULTS:The mean age of the patients was 50.4 ± 13.8 years and mean follow-up was 43 ± 29 months. Of the patients, 24% had progressive CKD and 19.7% developed hyperkalemia. Patients with a progressive course had lower FT3 levels (2.71 ± 0.34 vs. 3.17±0.47; p <0.001). Similarly hyperkalemic patients had lower FT3 values (2.77 ± 0.34 vs. 3.13 ± 0.49; p = 0.011). FT3 levels were negatively correlated with, age, history of hypertension and serum potassium level and positively correlated with serum albumin and eGFR levels. In multivariate regression analysis, FT3 levels were independently associated with progression of CKD. Low eGFR and RAS-blocker use was independently associated with the development of hyperkalemia. CONCLUSION:In patients with solitary kidney, low FT3 level is associated with the progression of CKD. In addition, development of hyperkalemia is common in CKD patients with low FT3 levels. KEy wORDS:Chronic kidney disease, Hyperkalemia, Low T3 syndrome, Solitary kidney, Thyroid hormones Öz AMAÇ: Çalışmanın amacı ötiroid soliter böbrekli hastalarda düşük serbest T3 seviyelerinin, KBH ilerlemesi ve hiperkalemi üzerine etkilerini incelemektir. GEREÇ ve yÖNTEMLER:Poliklinikte izlenen 76 tek böbrekli erişkin hasta çalışmaya dahil edildi. Tiroid hastalığı olanlar çalışma dışı bırakıldı. Başlangıç ve son kontrol laboratuvar sonuçları değerlendirildi. Tiroid hormon testlerine (TSH, sT4 ve sT3) başlangıçta bakıldı. BULGULAR:Hastaların yaş ortalamaları 50,4±13,8 yıl ve ortalama takip süresi 43±29 aydı. Hastaların %24'de KBH'da ilerleme ve %19,7'de hiperkalemi gelişti. KBH'da ilerleme gösteren hastalarda sT3 seviyeleri daha düşüktü (2,71±0,34 vs. 3,17±0,47; p <0,001). Benzer şekilde hiperkalemi gelişen hastalarda sT3 seviyeleri daha düşüktü (2,77±0,34 vs. 3,13±0,49; p =0,011). sT3 seviyesi yaş, hipertansiyon öyküsü ve potasyum düzeyi ile negatif, serum albümin ve GFH ile pozitif koreleydi. Çoklu analizde; sT3 düzeyi KBH progresyonu ile, hiperkalemi gelişimi ise düşük GFH ve RAS bloker kullanımıyla bağımsız ilişkiliydi. SONUÇ:Soliter böbrekli hastalarda düşük serbest T3 seviyeleri KBH ilerlemisi ile ilişkilidir. Düşük sT3 seviyeli KBH hastalarında hiperkalemi gelişimi sıktır.

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Section: Discussionsupporting

confidence: 66%

The Effect of Low FT3 Level on Kidney Disease Progression and Potassium Levels in Euthyroid Adult Patients with Solitary Kidney

Tatar¹,

Uslu²,

Atakaya³

et al. 2017

Turk Neph Dial Transpl

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“…In previous epidemiological studies, the evidence indicated that low T3 syndrome was an independent prognostic factor in CKD (Fan et al , ), acute cerebrovascular disorders (Bunevicius et al , ), community acquired pneumonia (Liu et al , ), chronic heart failure (Chen et al , ) and haemodialysis patients (Fragidis et al , ). In consensus with our results, Fan et al () reported that serum T3 was positively related to protein metabolism (albumin) and anaemia indicators (Hb), and negatively related to inflammatory status (CRP).…”

Section: Discussionmentioning

confidence: 94%

“…Although low T3 syndrome can be seen as an adaptive mechanism to counteract excessive catabolism and support immune response during acute phase, it might exert disadvantages as critical illness enters a chronic phase, necessitating prolonged life support as confirmed in preclinical and clinical studies (Van den Berghe, ; Weekers et al , ). Several observational studies indicated that low T3 syndrome was an independent prognostic factor for seriously ill hospitalized patients, including those who had septic shock, multiple trauma, severe burn, acute cerebrovascular disorders, community‐acquired pneumonia, chronic kidney disease (CKD), chronic liver failure and heart failure (Gangemi et al , ; Du et al , ; Agiasotelli et al , ; Bunevicius et al , ; Chen et al , ; Fan et al , ; Liu et al , ). With regard to cancer risk and cancer mortality, an evident association was identified between low T3 syndrome and metastasized cancer in a hospitalized older population ( P = 0·0002) (Tognini et al , ).…”

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confidence: 99%

Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma

et al. 2017

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The aim of this study was to evaluate the prognostic effect of low triiodothyronine (T3) syndrome on patients with diffuse large B cell lymphoma (DLBCL). A hundred and eighty-eight patients with detailed thyroid hormone levels at diagnosis of DLBCL were enrolled. Low T3 syndrome was defined as a low serum free T3 (FT3) level with low or normal serum free tetraiodothyronine (FT4) and thyroid stimulating hormone levels. Multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). Receiver-operator characteristic curves and the corresponding areas under the curve were calculated to assess the predictive accuracy of International Prognostic Index (IPI) and low T3 syndrome. Twenty-four patients were diagnosed with low T3 syndrome, which was associated with worse PFS and OS in the rituximab era. It was an independent prognostic factor for PFS and OS, especially for those with IPI 0-2, extranodal sites ≤1 and stage III-IV. Synchronously low FT3 and FT4 had poorer survival outcome compared to only low FT3 and adding criterion of low T3 syndrome improved the prognostic capacity of IPI for predicting PFS and OS in DLBCL. Low T3 syndrome was found to be a strong prognostic predictor in DLBCL.

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“…It suggested that fT3 level was correlated to the severity of HF in patients receiving CRT, which agreed with the previous studies. [17][18][19][20] Low fT3 level in HF reduced metabolic demand, which was seen as an adaptive process for HF. 21) But persistently low fT3 represented a maladaptive mechanism in favor of structural and functional cardiac remodeling, which had a key role in the pathogenesis of HF.…”

Section: Discussionmentioning

confidence: 99%

“…Low fT3 level reduced ejection fraction, and further caused enlarged heart chambers, lower velocity in the left atrial appendage and severe mitral regurgitation, which finally reduced cardiac systolic function. Thirdly, low-normal fT3 could affect several arteriosclerotic risk factors, such as diabetes mellitus, 17) insulin resistance, 20) serum lipid levels 23) and artery stiffness, 24) all of them above had been proved to have adverse effects on progress of HF. Fourthly, low fT3 status was independently correlated to peak oxygen uptake and functional exercise capacity in severe HF, which made recurrence of HF more frequent and remission period shorter than those with normal range of fT3.…”

Section: Discussionmentioning

confidence: 99%

A Low-Normal Free Triiodothyronine Level Is Associated with Adverse Prognosis in Euthyroid Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

Chen

Shu

et al. 2017

Int. Heart J.

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SummaryThyroid dysfunction is prevalent in patients with heart failure (HF) and hypothyroidism is related to the adverse prognosis of HF subjects receiving cardiac resynchronization therapy (CRT). We aim to investigate whether low-normal free triiodothyronine (fT3) level is related to CRT response and the prognosis of euthyroid patients with HF after CRT implantation.One hundred and thirteen euthyroid patients who received CRT therapy without previous thyroid disease and any treatment affecting thyroid hormones were enrolled. All of patients were evaluated for cardiac function and thyroid hormones (serum levels of fT3, free thyroxine [fT4] and thyroid-stimulating hormone [TSH]). The end points were overall mortality and hospitalization for HF worsening. During a follow-up period of 39 ± 3 weeks, 36 patients (31.9%) died and 45 patients (39.8%) had hospitalization for HF exacerbation. A higher rate of NYHA III/IV class and a lower fT3 level were both observed in death group and HF event group. Multivariate Cox regression analyses disclosed that a lower-normal fT3 level (HR = 0.648, P = 0.009) and CRT response (HR = 0.441, P = 0.001) were both independent predictors of overall mortality. In addition, they were also both related to HF re-hospitalization event (P < 0.01 for both). Patients with fT3 < 3.00 pmol/L had a significantly higher overall mortality than those with fT3 !3.00 pmol/L (P = 0.027). Meanwhile, a higher HF hospitalization event rate was also found in patients with fT3 < 3.00 pmol/L (P < 0.001).A lower-normal fT3 level is correlated with a worse cardiac function an adverse prognosis in euthyroid patients with HF after CRT implantation.(Int Heart J 2017; 58: 908-914) Key words: Thyroid hormones, Cardiac dysfunction, Left ventricular dyssynchrony, CRT response, Mortality, Hospitalization C ardiac resynchronization therapy (CRT) is a considerable treatment for patients with drugrefractory heart failure (HF) and electromechanical dyssynchronoy.1,2) Though CRT improves heart failure symptoms and quality of life, and reduces both HF-related morbidity and mortality, non-response to CRT has been reported in nearly one third of patients.3) The reason of non-response to CRT is complicated and remains a question of different opinions.Thyroid hormones (THs) have cardiac and vascular effects, and they also regulate biochemical reactions in most tissues.4) TH consists of thyroxine (T4) and triiodothyronine (T3), and the cardiac myocyte does not convert T4 to T3. In other word, T3 is the bioactive form of thyroid hormone for cardiomyocytes and plays an important role in cardiovascular regulation. Many studies have confirmed that T3 is a prognostic predictor or risk stratification of HF.5-7) Recently, fT3 level was shown to be associated with cardiac function and heart structure in euthyroid subjects without HF.8) In addition, another research reported hypothyroidism was associated with a worse prognosis after CRT implantation, but it did not supply values for complete thyroid panel (fT3 and fT4). 9) Is the prognos...

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Free Triiodothyronine Levels and Short-Term Prognosis in Chronic Heart Failure Patients With Type 2 Diabetes

Cited by 17 publications

References 37 publications

The Effect of Low FT3 Level on Kidney Disease Progression and Potassium Levels in Euthyroid Adult Patients with Solitary Kidney

The Effect of Low FT3 Level on Kidney Disease Progression and Potassium Levels in Euthyroid Adult Patients with Solitary Kidney

Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma

A Low-Normal Free Triiodothyronine Level Is Associated with Adverse Prognosis in Euthyroid Patients with Heart Failure Receiving Cardiac Resynchronization Therapy

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