Usefulness of Serum Free Thyroxine Concentration to Predict Ventricular Arrhythmia Risk in Euthyroid Patients With Structural Heart Disease

Müller, Patrick; Dietrich, Johannes W.; Lin, Tina; Bejinariu, Alexandru; Binnebößel, Stephan; Bergen, Friederike; Schmidt, Jan; Müller, Sarah-Kristin; Chatzitomaris, Apostolos; Kurt, Muhammed; Gerguri, Shqipe; Clasen, Lukas; Klein, Harald; Kelm, Malte; Makimoto, Hisaki

doi:10.1016/j.amjcard.2020.01.019

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…Recently, a similar pattern of dichotomous TSH levels but consistently high FT4 concentrations was described to be associated to malignant arrhythmia in patients with structural heart disease [48]. This is consistent with the results of large population-based studies [55,56].…”

Section: Discussionsupporting

confidence: 86%

“…In cases with high‐normal FT4 levels sensitization of myocardial tissue to catecholamines may result from hormone concentrations above the personal set point of thyroid homeostasis [47]. Recently, a similar pattern of dichotomous TSH levels but consistently high FT4 concentrations was described to be associated to malignant arrhythmia in patients with structural heart disease [48]. This is consistent with the results of large population‐based studies [55, 56].…”

Section: Discussionsupporting

confidence: 70%

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

et al. 2020

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 70%

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

et al. 2020

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“…In line with this, a systematic review and individual participant meta-analysis in euthyroid individuals documented that FT4 but not TSH is associated with increased risk of incident atrial fibrillation [21]. Other studies have shown that higher fT4 but not TSH was significantly associated with an increased risk of ventricular arrhythmias and sudden cardiac death [16,22]. The finding that SPI-NA-GT was significantly associated with RHR, whereas there was only a non-significant trend for JTI, suggests that impending primary hyperthyroidism rather than an elevated set point of thyroid homeostasis may have driven our results.…”

Section: Discussionmentioning

confidence: 72%

“…NTIS was diagnosed in participants with reduced FT3 ( < 2.8 pmol/l) and non-elevated TSH ( ≤ 4.2 mU/l). To evaluate the relative contribution of the pituitary and thyroid gland to the variations in thyroid hormone concentrations we calculated Jostel´s TSH index (JTI), a measure of pituitary thyrotropic function, and the calculated secretory capacity of the thyroid gland (SPINA-GT), a measure for the maximum secretion rate of the thyroid gland under stimulated conditions, according to previous publications [16][17][18]. Other laboratory parameters were measured as described elsewhere [14].…”

Section: Methodsmentioning

confidence: 99%

Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography

et al. 2020

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Resting heart rate (RHR) is associated with increased risk of cardiovascular morbidity and mortality. Thyroid hormones exert several effects on the cardiovascular system, but the relation between thyroid function and RHR remains to be further established. We evaluated whether measures of thyroid hormone status are associated with RHR in patients referred to coronary angiography. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxin (FT4), and RHR were determined in 2795 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study. Median (25th to 75th percentile) serum concentrations were 1.25 (0.76–1.92) mU/l for TSH, 4.8 (4.2–5.3) pmol/l for FT3 and 17.1 (15.4-19.0) pmol/l for FT4, and mean (±standard deviation) RHR was 68.8 (±11.7) beats/min. Comparing the highest versus the lowest quartile, RHR (beats/min) was significantly higher in the fourth FT4 quartile [3.48, 95% confidence interval (CI): 2.23–4.73; p <0.001] and in the fourth FT3 quartile (2.30, 95% CI: 1.06–3.55; p <0.001), but there was no significant difference for TSH quartiles. In multiple linear regression analyses adjusting for various potential confounders, FT3 and FT4 were significant predictors of RHR (p <0.001 for both). In subgroups restricted to TSH, FT3, and FT4 values within the reference range, both FT3 and FT4 remained significant predictors of RHR (p <0.001 for all). In conclusion, in patients referred to coronary angiography, FT3 and FT4 but not TSH were positively associated with RHR. The relationship between free thyroid hormones and RHR warrants further investigations regarding its diagnostic and therapeutic implications.

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“…At least in elderly subjects, the benefits of levothyroxine substitution are questionable (5). While increased and high-normal free thyroxine (FT4) concentration is a well-established risk factor for malignant arrhythmia and sudden cardiac death (6,7), the association between thyrotropin (TSH) concentration and cardiovascular mortality is less well understood (8)(9)(10)(11). Studies reported either no relation at all (12,13) or a rather complex Ushaped association (14,15), as has been shown in a recent population study based on the large NHANES datasets (16).…”

Section: Introductionmentioning

confidence: 99%

The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Dietrich

Hoermann²,

Midgley

et al. 2020

Front. Endocrinol.

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Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified via MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk via an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.

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Usefulness of Serum Free Thyroxine Concentration to Predict Ventricular Arrhythmia Risk in Euthyroid Patients With Structural Heart Disease

Cited by 11 publications

References 14 publications

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

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

Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography

The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

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