Volume: 8 Issue: 3
Year: 2020, Page: 20-24, Doi: https://doi.org/10.47799/pimr.0803.05
Background: Effect of thyroid hormone on cardiac functions is mediated by biologically active T3 which binds to nuclear TR. There is increasing evidence that patients with mild thyroid dysfunctions are presenting with adverse cardiovascular manifestations which includes heart failure.
Aim: The present study aimed to determine the existence of low T3 syndrome in patients with chronic heart failure. Material and Methods: This prospective study was conducted in the Department of General Medicine and Cardiology, KMC, and MGM Hospital, Warangal. patients with heart failure were included in the study. A total of n=100 patients were included in the study detailed physical examination was conducted to assess the patient's volume status (rales, edema, jugular venous distension), weight, height, body mass index, and orthostatic blood pressure changes. Complete blood count, blood glucose (fasting and 2 hours postprandial), Fasting serum lipid profile, blood urea, serum creatinine, and serum electrolytes were measured in all patients. Two-dimensional echocardiography was done in patients.
Results: Analysis of Echocardiography parametersCompared to patients who were alive (n=90),left ventricular end-diastolic diameter was higher in those whodied (n=10). The mean ejection fraction in died and alive groups were27.19% and 35.12% respectively. Persons who died had asignificantly lower ejection fraction than those alive.When the mean ejection fraction was compared betweenpatients with low total T3 (T3<80 ng/dl) and normal T3 , patients with low T3 had a mean ejection fraction of 29.2% and those with normal T3 levels had a mean ejection fraction of 34.78%. This indicates the mean ejection fraction is lower in patients with low total T3 levels.
Conclusion: Within the limitations of the present study it can be concluded that the prevalence of low T3 syndrome in patients with chronic heart failure is common. It was found that patients with lower T3 levels were having a lower ejection fraction.The LVEDD diameterwas negatively correlated with total T3. Therefore, Total T3 levels can be used as an adjunct to other parameters for risk stratification and survival estimation in chronic heart failure.
Keywords: Low T3 Syndrome, Chronic Heart Failure,Ejection fraction, Left ventricular end-diastolic diameter
1. Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M.Feldman et al. ACC/AHA 2005 Guideline Update for the Diagnosisand Management of Chronic Heart Failure in the Adult—SummaryArticle: A Report of the American College of Cardiology/AmericanHeart Association Task Force on Practice Guidelines. Circulation. 2005; 112: 1825-52.
2. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. New England Journal of Medicine.2002: 347; 1397-02.
3. Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L. Hormonesregulating cardiovascular function in patients with severe congestiveheart failure and their relation to mortality. CONSENSUS TrialStudyGroup.Circulation. 1990; 82: 1730 –36.
4. Iervasi G, Emdin M, Colzani RMP, et al. Beneficial effects of long-term triiodothyronine (T3) infusion in patients with advanced heart failure and low T3 syndrome. In: Kimchi A, editor. Proceedings of the 2nd International Congress on Heart Disease—New Trends in Research, Diagnosis, and Treatment. Washington, DC, USA: Medimond Medical Publications; 2001; 549–553.
5. Hamilton MA, Stevenson LW, Fonarow GC: Safety andhemodynamic effects of intravenous triiodothyronine in advanced56congestive heart failure. American Journal of Cardiology 1998; 81:443–447.
6. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system.N Engl J Med. 2001; 344:501–09.
7. Iervasi G, Pingitore A, Landi P. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation.2003;107:708–13.
8. Kodzag G, Ural D, Vural A, et al. Relation between free triiodothyronine/free thyroxine ratio, echocardiographic parameters, and mortality in dilated cardiomyopathy. Eur J Heart Fail. 2005; 7:113–18.
9. Pingitore A, Landi P, Taddei MC, et al.Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med. 2005; 118:132–36.
10. Opasich C, Pacini F, AmbrosinoN,RiccardiPG,Febo O et al. Sickeuthyroid syndrome in patients with moderate-tosevere chronic heart failure.European Heart Journal.1996;17(12):1860-66.
11. Hamilton MA, Stevenson LW, Luu M, et al. Altered thyroid hormonemetabolism in advanced heart failure. J Am Coll Cardiol. 1990; 16:91–95.
12. Zargar AH, GanieMA,Masoodi SR et al. Prevalence and pattern ofthe sick euthyroid syndrome in acute and chronic non-thyroidal illness—its relationship with the severity and outcome of the disorder. Pattern and prevalence of sick euthyroid syndrome in this part of the world. J Assoc Physicians India. 2004; 52:27-31.
13. Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med. 1995; 333:1522–7.
14. Hamilton MA, Stevenson LW, Fonarow GC, et al. Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure. Am J Cardiol. 1998; 81:443–47.
15. Pennock GD, Raya TE, Bahl JJ. Combination treatment with captopril and the thyroid hormone analog 3,5- diiodothyropropionic acid. A new approach to improving left ventricular performance in heart failure. Circulation. 1993; 88:1289–98.
16. Morkin E, Ladenson P, Goldman S, et al. Thyroid hormone analogs for the treatment of hypercholesterolemia and heart failure: past, present, and future prospects. J Mol Cell Cardiol 2004; 37:1137–46.
© 2020-21 Prathima Institue of Medical Sciences
Gururaj N, Voruganti N. The Prevalence of low T3 syndrome in chronic heart failure: A Hospital-based study. Perspectives in Medical Research 2020; 8 (3):20-24. DOI: 10.47799/pimr.0803.05