Document Detail

Thyroid hormones and the stunned myocardium.
MedLine Citation:
PMID:  25128568     Owner:  NLM     Status:  Publisher    
Acute critically ill patients experience a rapid decline in plasma free thyroid hormone levels (free triiodothyronine [FT3] and free levothyroxine [FT4]), with a marked elevation of reverse T3, recognized as the euthyroid sick syndrome (ESS) or low-T3 syndrome. The ESS is also often associated with depressed myocardial function, sometimes referred to as the "stunned myocardium". Its clinical impact may vary from minimal hemodynamic impairment to cardiogenic shock. Medical management may range from aspirin alone to placement of a left ventricular assist device. With adequate supportive therapy, recovery usually occurs within days or weeks. The effect of T3/T4 therapy has been studied in three conditions in which the ESS and myocardial functional depression have been documented - (i) transient regional myocardial ischemia and reperfusion, (ii) transient global myocardial ischemia in patients undergoing cardiac surgery on cardiopulmonary bypass, and (iii) transient inadequate global myocardial perfusion in brain-dead potential organ donors. In all three conditions, myocardial ischemia leads to rapid loss of high energy phosphates, accumulation of myocardial tissue lactate, and probably loss of homeostasis of cytosolic calcium, which may further increase cell injury. There is an inability to generate ATP through the Krebs cycle, which reduces the high energy phosphate pool essential for all cell ATPases. In all three conditions, following administration of T3/T4, the myocardial dysfunction was rapidly reversed. We therefore cautiously advocate the use of thyroid hormonal therapy to any patient with the ESS and/or a stunned myocardium.
Dimitri Novitzky; David K C Cooper
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-15
Journal Detail:
Title:  The Journal of endocrinology     Volume:  -     ISSN:  1479-6805     ISO Abbreviation:  J. Endocrinol.     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375363     Medline TA:  J Endocrinol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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