Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1984 Aug;52(2):215–222. doi: 10.1136/hrt.52.2.215

Delayed recovery of left ventricular function after antithyroid treatment. Further evidence for reversible abnormalities of contractility in hyperthyroidism.

J C Forfar, D M Matthews, A D Toft
PMCID: PMC481612  PMID: 6743439

Abstract

Sequential measurements of systolic time intervals, left ventricular dimensions, and the derived indices of contractility were undertaken at rest and during isometric exercise in 15 hyperthyroid patients before, during, and after antithyroid treatment. At rest hyperthyroidism was characterised by a shortened pre-ejection period and increased velocity of circumferential shortening of the left ventricle. During isometric exercise, however, the pre-ejection period increased significantly beyond that predicted for normal subjects, and the velocity of circumferential fibre shortening fell by 30%. In contrast, both the pre-ejection period and the velocity of circumferential fibre shortening were unchanged during exercise after a stable euthyroid state had been achieved for at least three months. Comparison between exercise responses and thyroid status during antithyroid treatment showed that a biochemical euthyroid state may be achieved many weeks before normalisation of contractile response to exercise. These findings support the hypothesis of reversible depression of left ventricular function in hyperthyroidism. Responses at rest principally reflect the peripheral actions of thyroid hormone excess.

Full text

PDF
215

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buccino R. A., Spann J. F., Jr, Pool P. E., Sonnenblick E. H., Braunwald E. Influence of the thyroid state on the intrinsic contractile properties and energy stores of the myocardium. J Clin Invest. 1967 Oct;46(10):1669–1682. doi: 10.1172/JCI105658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burckhardt D., Staub J. J., Kraenzlin M., Raeder E., Engel U., Cloppenburg P. The systolic time intervals in thyroid dysfunction. Am Heart J. 1978 Feb;95(2):187–196. doi: 10.1016/0002-8703(78)90462-3. [DOI] [PubMed] [Google Scholar]
  3. Chakravarty J., Guansing A. R., Chakravarty S., Hughes C. V. Systolic time intervals (STI) as indicators of myocardial thyroid hormone effect. A correlative study in hypothyroid and hyperthyroid patients. Acta Endocrinol (Copenh) 1978 Mar;87(3):507–515. doi: 10.1530/acta.0.0870507. [DOI] [PubMed] [Google Scholar]
  4. Clark R. D., Korcuska K., Cohn K. Serial echocardiographic evaluation of left ventricular function in valvular disease, including reproducibility guidelines for serial studies. Circulation. 1980 Sep;62(3):564–575. doi: 10.1161/01.cir.62.3.564. [DOI] [PubMed] [Google Scholar]
  5. Cohen M. V., Schulman I. C., Spenillo A., Surks M. I. Effects of thyroid hormone on left ventricular function in patients treated for thyrotoxicosis. Am J Cardiol. 1981 Jul;48(1):33–38. doi: 10.1016/0002-9149(81)90569-5. [DOI] [PubMed] [Google Scholar]
  6. DeGroot W. J., Leonard J. J. Hyperthyroidism as a high cardiac output state. Am Heart J. 1970 Feb;79(2):265–275. doi: 10.1016/0002-8703(70)90318-2. [DOI] [PubMed] [Google Scholar]
  7. Forfar J. C., Muir A. L., Sawers S. A., Toft A. D. Abnormal left ventricular function in hyperthyroidism: evidence for a possible reversible cardiomyopathy. N Engl J Med. 1982 Nov 4;307(19):1165–1170. doi: 10.1056/NEJM198211043071901. [DOI] [PubMed] [Google Scholar]
  8. GRAETTINGER J. S., MUENSTER J. J., SELVERSTONE L. A., CAMPBELL J. A. A correlation of clinical and hemodynamic studies in patients with hyperthyroidism with and without congestive heart failure. J Clin Invest. 1959 Aug;38(8):1316–1327. doi: 10.1172/JCI103906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gibson J. G., Harris A. W. CLINICAL STUDIES OF THE BLOOD VOLUME. V. HYPERTHYROIDISM AND MYXEDEMA. J Clin Invest. 1939 Jan;18(1):59–65. doi: 10.1172/JCI101026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Helfant R. H., De Villa M. A., Meister S. G. Effect of sustained isometric handgrip exercise on left ventricular performance. Circulation. 1971 Dec;44(6):982–993. doi: 10.1161/01.cir.44.6.982. [DOI] [PubMed] [Google Scholar]
  11. Ikram H. Haemodynamic effects of beta-adrenergic blockade in hyperthyroid patients with and without heart failure. Br Med J. 1977 Jun 11;1(6075):1505–1507. doi: 10.1136/bmj.1.6075.1505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Irvine W. J., Toft A. D., Hunter W. M., Kirkham K. E. An assessment of plasma TSH radioimmunoassay and of the TSH stimulation test in the diagnosis of 100 consecutive patients with suspected hypothyroidism. Clin Endocrinol (Oxf) 1973 Apr;2(2):135–139. doi: 10.1111/j.1365-2265.1973.tb00413.x. [DOI] [PubMed] [Google Scholar]
  13. Lewis B. S., Ehrenfeld E. N., Lewis N., Gotsman M. S. Echocardiographic LV function in thyrotoxicosis. Am Heart J. 1979 Apr;97(4):460–468. doi: 10.1016/0002-8703(79)90393-4. [DOI] [PubMed] [Google Scholar]
  14. Lindquist V. A., Spangler R. D., Blount S. G., Jr A comparison between the effects of dynamic and isometric exercise as evaluated by the systolic time intervals in normal man. Am Heart J. 1973 Feb;85(2):227–236. doi: 10.1016/0002-8703(73)90464-x. [DOI] [PubMed] [Google Scholar]
  15. Litten R. Z., 3rd, Martin B. J., Low R. B., Alpert N. R. Altered myosin isozyme patterns from pressure-overloaded and thyrotoxic hypertrophied rabbit hearts. Circ Res. 1982 Jun;50(6):856–864. doi: 10.1161/01.res.50.6.856. [DOI] [PubMed] [Google Scholar]
  16. Merillon J. P., Passa P., Chastre J., Wolf A., Gourgon R. Left ventricular function and hyperthyroidism. Br Heart J. 1981 Aug;46(2):137–143. doi: 10.1136/hrt.46.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Murayama M., Goodkind M. J. Effect of thyroid hormone on the frequency-force relationship of atrial myocardium from the guinea pig. Circ Res. 1968 Dec;23(6):743–751. doi: 10.1161/01.res.23.6.743. [DOI] [PubMed] [Google Scholar]
  19. Pannier J. L. The influence of thyroid hormone on myocardial contractility. Arch Int Physiol Biochim. 1968 Jul;76(3):477–490. doi: 10.3109/13813456809058720. [DOI] [PubMed] [Google Scholar]
  20. Parisi A. F., Hamilton B. P., Thomas C. N., Mazzaferri E. L. The short cardiac pre-ejection period: an index to thyrotoxicosis. Circulation. 1974 May;49(5):900–904. doi: 10.1161/01.cir.49.5.900. [DOI] [PubMed] [Google Scholar]
  21. Sahn D. J., DeMaria A., Kisslo J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978 Dec;58(6):1072–1083. doi: 10.1161/01.cir.58.6.1072. [DOI] [PubMed] [Google Scholar]
  22. Seth J., Toft A. D., Irvine W. J. Simple solid-phase radioimmunoassays for total tri-iodothyronine and thyroxine in serum, and their clinical evaluation. Clin Chim Acta. 1976 May 3;68(3):291–301. doi: 10.1016/0009-8981(76)90394-6. [DOI] [PubMed] [Google Scholar]
  23. Siegel W., Gilbert C. A., Nutter D. O., Schlant R. C., Hurst J. W. Use of isometric handgrip for the indirect assessment of left ventricular function in patients with coronary atherosclerotic heart disease. Am J Cardiol. 1972 Jul 11;30(1):48–54. doi: 10.1016/0002-9149(72)90124-5. [DOI] [PubMed] [Google Scholar]
  24. Suga H., Sagawa K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res. 1974 Jul;35(1):117–126. doi: 10.1161/01.res.35.1.117. [DOI] [PubMed] [Google Scholar]
  25. Taylor R. R. Contractile properties of cardiac muscle in hyperthyroidism. Analysis of behavior of hyperthyroid cat papillary muscle in vitro relevant to thyrotoxic heart disease. Circ Res. 1970 Oct;27(4):539–549. doi: 10.1161/01.res.27.4.539. [DOI] [PubMed] [Google Scholar]
  26. Ueda H., Sugishita Y., Nakanishi A., Ito I., Yasuda H., Sugiura M., Takabatake Y., Ueda K., Koide T., Ozeki K. Clinical studies on the cardiac performance by means of transseptal left heart catheterization. II. Left ventricular function in high output heart diseases, especially in hyperthyroidism. Jpn Heart J. 1965 Sep;6(5):396–406. doi: 10.1536/ihj.6.396. [DOI] [PubMed] [Google Scholar]
  27. Weissler A. M., Harris W. S., Schoenfeld C. D. Systolic time intervals in heart failure in man. Circulation. 1968 Feb;37(2):149–159. doi: 10.1161/01.cir.37.2.149. [DOI] [PubMed] [Google Scholar]
  28. Young R. T., Van Herle A. J., Rodbard D. Improved diagnosis and management of hyper- and hypothyroidism by timing the arterial sounds. J Clin Endocrinol Metab. 1976 Feb;42(2):330–340. doi: 10.1210/jcem-42-2-330. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES