Altered thyroid hormone metabolism in advanced heart failure

Division of Cardiology, University of California, Los Angeles School of Medicine 90024-1679.

To determine the prevalence and significance of abnormal thyroid hormone metabolism in congestive heart failure, free thyroxine (T4) index, free triiodothyronine (T3) index, reverse T3 and thyrotropin levels were obtained in 84 hospitalized patients with chronic advanced heart failure. Free T4 index was normal in all patients. Free T3 index was reduced or reverse T3 elevated, or both, leading to a low free T3 index/reverse T3 ratio in 49 (58%) of the 84 patients. A low free T3 index/reverse T3 ratio was associated with higher right atrial, pulmonary artery and pulmonary capillary wedge pressures and lower ejection fraction, cardiac index, serum sodium, albumin and total lymphocyte count. In multivariate analysis, the free T3 index/reverse T3 ratio was the only independent predictor of poor 6 week outcome (p less than 0.001); the actuarial 1 year survival rate was 100% for patients with a normal ratio and only 37% for those with a low ratio (p less than 0.0001). A low free T3 index/reverse T3 ratio is associated with poor ventricular function and nutritional status and is the strongest predictor yet identified for short-term outcome in patients with advanced heart failure.

This article has been cited by other articles:

				R. Rouf, S. Greytak, E. C. Wooten, J. Wu, J. Boltax, M. Picard, E. C. Svensson, W. H. Dillmann, R. D. Patten, and G. S. Huggins Increased FOG-2 in Failing Myocardium Disrupts Thyroid Hormone-Dependent SERCA2 Gene Transcription Circ. Res., August 29, 2008; 103(5): 493 - 501. [Abstract] [Full Text] [PDF]

				A. Pingitore, E. Galli, A. Barison, A. Iervasi, M. Scarlattini, D. Nucci, A. L'Abbate, R. Mariotti, and G. Iervasi Acute Effects of Triiodothyronine (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3 Syndrome: A Randomized, Placebo-Controlled Study J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1351 - 1358. [Abstract] [Full Text] [PDF]

				I. Klein and S. Danzi Thyroid Disease and the Heart Circulation, October 9, 2007; 116(15): 1725 - 1735. [Abstract] [Full Text] [PDF]

				E. L. Olivares, M. P. Marassi, R. S. Fortunato, A. C. M. da Silva, R. H. Costa-e-Sousa, I. G. Araujo, E. C. Mattos, M. O. Masuda, M. A. Mulcahey, S. A. Huang, et al. Thyroid Function Disturbance and Type 3 Iodothyronine Deiodinase Induction after Myocardial Infarction in Rats A Time Course Study Endocrinology, October 1, 2007; 148(10): 4786 - 4792. [Abstract] [Full Text] [PDF]

				G. Iervasi, S. Molinaro, P. Landi, M. C. Taddei, E. Galli, F. Mariani, A. L'Abbate, and A. Pingitore Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients Arch Intern Med, July 23, 2007; 167(14): 1526 - 1532. [Abstract] [Full Text] [PDF]

				R. Napoli, V. Guardasole, V. Angelini, E. Zarra, D. Terracciano, C. D'Anna, M. Matarazzo, U. Oliviero, V. Macchia, and L. Sacca Acute Effects of Triiodothyronine on Endothelial Function in Human Subjects J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 250 - 254. [Abstract] [Full Text] [PDF]

				W. I. Khalife, Y.-D. Tang, J. A. Kuzman, T. A. Thomas, B. E. Anderson, S. Said, P. Tille, E. H. Schlenker, and A. M. Gerdes Treatment of subclinical hypothyroidism reverses ischemia and prevents myocyte loss and progressive LV dysfunction in hamsters with dilated cardiomyopathy Am J Physiol Heart Circ Physiol, December 1, 2005; 289(6): H2409 - H2415. [Abstract] [Full Text] [PDF]

				G. J. Kahaly and W. H. Dillmann Thyroid Hormone Action in the Heart Endocr. Rev., August 1, 2005; 26(5): 704 - 728. [Abstract] [Full Text] [PDF]

				K. Kinugawa, M. Y. Jeong, M. R. Bristow, and C. S. Long Thyroid Hormone Induces Cardiac Myocyte Hypertrophy in a Thyroid Hormone Receptor {alpha}1-Specific Manner that Requires TAK1 and p38 Mitogen-Activated Protein Kinase Mol. Endocrinol., June 1, 2005; 19(6): 1618 - 1628. [Abstract] [Full Text] [PDF]

				M. Emdin, C. Marini, C. Passino, D. Giuggioli, B. Formichi, C. Ferri, J. Khabirinejad, R. Poletti, C. Prontera, A. Iervasi, et al. Right ventricular overload and cardiovascular neuroendocrine derangement in systemic sclerosis Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F68 - F73. [Abstract] [Full Text] [PDF]

				S. Fazio, E. A. Palmieri, G. Lombardi, and B. Biondi Effects of Thyroid Hormone on the Cardiovascular System Recent Prog. Horm. Res., January 1, 2004; 59(1): 31 - 50. [Abstract] [Full Text]

				G. Iervasi, A. Pingitore, P. Landi, M. Raciti, A. Ripoli, M. Scarlattini, A. L'Abbate, and L. Donato Low-T3 Syndrome: A Strong Prognostic Predictor of Death in Patients With Heart Disease Circulation, February 11, 2003; 107(5): 708 - 713. [Abstract] [Full Text] [PDF]

				H.N. Pavlou, P.A. Kliridis, A.A. Panagiotopoulos, C.P. Goritsas, and P.J. Vassilakos Euthyroid Sick Syndrome in Acute Ischemic Syndromes Angiology, November 1, 2002; 53(6): 699 - 707. [Abstract] [PDF]

				L. Friberg, S. Werner, G. Eggertsen, and S. Ahnve Rapid Down-regulation of Thyroid Hormones in Acute Myocardial Infarction: Is It Cardioprotective in Patients With Angina? Arch Intern Med, June 24, 2002; 162(12): 1388 - 1394. [Abstract] [Full Text] [PDF]

				R. Napoli, B. Biondi, V. Guardasole, M. Matarazzo, F. Pardo, V. Angelini, S. Fazio, and L. Sacca Impact of Hyperthyroidism and Its Correction on Vascular Reactivity in Humans Circulation, December 18, 2001; 104(25): 3076 - 3080. [Abstract] [Full Text] [PDF]

				I. Klein and K. Ojamaa Thyroid Hormone and the Cardiovascular System N. Engl. J. Med., February 15, 2001; 344(7): 501 - 509. [Full Text] [PDF]

				K. Ojamaa, A. Kenessey, R. Shenoy, and I. Klein Thyroid hormone metabolism and cardiac gene expression after acute myocardial infarction in the rat Am J Physiol Endocrinol Metab, December 1, 2000; 279(6): E1319 - E1324. [Abstract] [Full Text] [PDF]

				C Berry and A.L Clark Catabolism in chronic heart failure Eur. Heart J., April 1, 2000; 21(7): 521 - 532. [PDF]

				S. L. Mullis-Jansson, M. Argenziano, S. Corwin, S. Homma, A. D. Weinberg, M. Williams, E. A. Rose, and C. R. Smith A RANDOMIZED DOUBLE-BLIND STUDY OF THE EFFECT OF TRIIODOTHYRONINE ON CARDIAC FUNCTION AND MORBIDITY AFTER CORONARY BYPASS SURGERY J. Thorac. Cardiovasc. Surg., June 1, 1999; 117(6): 1128 - 1135. [Abstract] [Full Text] [PDF]

				R. D. Utiger Altered Thyroid Function in Nonthyroidal Illness and Surgery -- To Treat or Not to Treat? N. Engl. J. Med., December 7, 1995; 333(23): 1562 - 1563. [Full Text]

				J. D. Walker, F. A. Crawford, and F. G. Spinale PRETREATMENT WITH 3,5,3' TRIIODO-L-THYRONINE (T3): Effects on myocyte contractile function after hypothermic cardioplegic arrest and rewarming J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 315 - 327. [Abstract] [Full Text]

				B. Murzi, G. Iervasi, S. Masini, R. Moschetti, V. Vanini, G. Zucchelli, and A. Biagini Thyroid Hormones Homeostasis in Pediatric Patients During and After Cardiopulmonary Bypass Ann. Thorac. Surg., February 1, 1995; 59(2): 481 - 485. [Abstract] [Full Text]

				J. D. Walker, F. A. Crawford, S. Kato, and F. G. Spinale The novel effects of 3,5,3'-triiodo-L-thyronine on myocyte contractile function and {beta}-adrenergic responsiveness in dilated cardiomyopathy J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 672 - 679. [Abstract] [Full Text]