“…This results from a dual action of the hormone: a direct one, which is due to stimulation of cardiomyocyte metabolism, and a second, indirect one, which occurs in response to increased demand of peripheral tissues for oxygen and substrates and for the removal of waste products (5,10). The combination of these effects, at least during the early phase of hyperthyroidism, leads to increased "contractility" of the hyperthyroid heart, which is manifested by positive changes in virtually all measurable parameters of cardiac muscle function (1,3,5,6,10,21,29,30,46). Excess thyroid hormone is associated with an increase in the number and volume of mitochondria in cardiac myocytes and skeletal muscle, and the resultant stimulation of oxidative phosphorylation is associated with increased numbers of respiratory units per milligram mitochondrial protein with little or no change in the phosphorylation-to-oxidation ratio (5,10,30,46).…”