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Early detection of isolated left ventricular diastolic dysfunction in high-risk differentiated thyroid carcinoma patients on TSH suppressive therapy.
MedLine Citation:
PMID:  21645022     Owner:  NLM     Status:  Publisher    
Objective:  L-Thyroxine suppressive therapy benefits high-risk differentiated thyroid cancer patients by decreasing recurrence rates, and cancer-related mortality. However, fully suppressed serum TSH implies a state of subclinical hyperthyroidism (SCH) with associated adverse cardiac effects. Because left ventricular (LV) diastolic dysfunction may be the first manifestation of more severe LV failure, and in order to balance the risks from thyroid cancer recurrence with risks of cardiac failure, the purpose of the present study was to analyze new parameters of LV function in asymptomatic patients with exogenous SCH. Design:  Case-control study with 24 patients on TSH suppressive therapy of short duration (≤4 years) after thyroid ablative therapy for differentiated thyroid carcinoma and 20 age- and sex-matched subjects. Measurements:  LV function (LV global strain and strain rate curves) was assessed by speckle tracking imaging echocardiography in each subject. Results Patients and controls do not differ in body mass index, systolic blood pressure and heart rate. No significant differences were observed in LV morphology (LV mass and relative wall thickness), cardiac output and parameters of LV systolic function between patients on suppressive therapy and controls. When compared to controls, patients with exogenous SCH had a significantly impaired longitudinal protodiastolic strain, strain rate and strain diastolic index but preserved radial strain and strain rate (SR) function. Conclusions:  In subjects with SCH at the early phase of TSH suppressive therapy, evidence of isolated longitudinal LV diastolic dysfunction was observed, despite a normal LV morphology. Further prospective studies to clarify the prognosis of picking-up early diastolic dysfunction in asymptomatic patients is needed before serial measurements could be recommended.
Véronique Taillard; Mathieu Sardinoux; Carole Oudot; Pierre Fesler; Caroline Rugale; Isabelle Raingeard; Eric Renard; Jean Ribstein; Guilhem du Cailar
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-6
Journal Detail:
Title:  Clinical endocrinology     Volume:  -     ISSN:  1365-2265     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Blackwell Publishing Ltd.
Department of Internal Medicine Department of Endocrinology, CHU Montpellier, Hôpital Lapeyronie 34295 Montpellier Cedex 5 France.
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