Prognostic implications of thyroid hormone alterations in acute coronary syndrome–A systematic review

Abstract

There is considerable association of thyroid function and the cardiovascular system during various acute systemic illnesses. It is well established that the normal thyroid homeostasis is known to alter in disease states including the acute coronary syndromes (ACS). Abnormal thyroid hormonal status has been shown to be related to worse outcomes and prognosis. This review focuses on the relationship of alterations in thyroid function and its influence on the pathophysiological mechanisms and cardiovascular hemodynamics in ACS and based upon the literature, summarises all the existing evidence to this date on this subject. The data largely points out that low levels of triiodothyronine (T3) levels seen in ACS might be useful in prognosticating the outcomes of ACS.

Thyroid dysfunction in acute coronary syndrome and its prognostic implications

“…These assume special importance in patients with ACS as reported in many studies. (Arambam et al 2021). Thyroid dysfunction is more common in female preponderance (52%), as seen in our study and this has been an observation in several other studies also.…”

Free triiodothyronine to free thyroxine ratio as a marker of poor prognosis in euthyroid patients with acute coronary syndrome and diabetes after percutaneous coronary intervention

“…The prevalence rate of ACS and diabetes was as high as 24%–30%, and the risk of in-hospital and long-term major adverse cardiovascular events and complications was significantly higher than that of patients without diabetes ( 5 , 6 ). Some previous retrospective studies with a small sample have found that the proportion of ACS patients with thyroid dysfunction is about 20%–30% ( 7 , 21 ). As is known to all, the rates of heart failure, nonfatal reinfarction, unplanned repeat revascularization, and all-cause or cardiac mortality are high in ACS patients with thyroid dysfunction, including hyperthyroidism, hypothyroidism, and even subclinical thyroid disease ( 7 , 8 , 22 ).…”

“…Some previous retrospective studies with a small sample have found that the proportion of ACS patients with thyroid dysfunction is about 20%–30% ( 7 , 21 ). As is known to all, the rates of heart failure, nonfatal reinfarction, unplanned repeat revascularization, and all-cause or cardiac mortality are high in ACS patients with thyroid dysfunction, including hyperthyroidism, hypothyroidism, and even subclinical thyroid disease ( 7 , 8 , 22 ). However, in euthyroid patients with normal serum thyroid function indexes, it is very critical to evaluate real thyroid function, identify thyroid dysfunction, and explore its relationship with the prognosis of ACS with diabetes ( 23 ).…”

“…Previous studies have also found that coronary heart disease and diabetes are closely related to thyroid hormone. Hyperthyroidism, hypothyroidism, and subclinical thyroid diseases are related to MACCE of cardiovascular system diseases ( 7 – 10 ). The potential mechanisms may include cellular inflammatory responses, vascular endothelial cell damage, dyslipidemia, atherosclerosis, and cardiac dysfunction ( 11 , 12 ).…”

A Cross-Sectional Study of Acute Coronary Syndrome and Thyroid Profile: Dissecting the Relationship to Improve Patient Care

“…"Euthyroid sick syndrome" stands out as the most prevalent condition in patients grappling with ACS. This condition is characterized by an alteration in the typical feedback regulation mechanism of thyroid homeostasis and presents with reduced levels of serum triiodothyronine (T3) and/or free triiodothyronine (fT3), elevated levels of serum reverse triiodothyronine (rT3), and concurrently normal levels of blood thyroid stimulating hormone (TSH), thyroxine (T4), and free thyroxine (fT4) [ 5 , 8 , 9 ]. Notably, this condition has been reported in many cases of severe chronic heart failure [ 10 , 11 ] and acute MI [ 12 , 13 ], and as a rapidly arising condition after open-heart surgery [ 8 ].…”