[Cardiac consequences of clinical dysthyroidism. Pathophysiological, clinical, and epidemiologic data].
Thyroid hormones affect the vascular system, including the diastolic and systolic functioning of the heart. Resting heart rate increases early in hyperthyroidism (cardiac contractility expands due to improved ventricular loading and decreased systemic vascular resistance). Paradoxically, these hemodynamic alterations progressively reduce cardiac performance on effort (changes in diastolic, then systolic functioning) and finally at rest (modification in ventricular loading following tachycardia or atrial fibrillation), especially in cases of underlying heart disease (in the elderly). Hypothyroidism has an inverse hemodynamic effect and is less noisy, usually limited to relative bradycardia. The morbidity and mortality associated with hypothyroidism are apparently related to the atherogenic and prothrombotic vascular modifications that follow thyroid hormone deficiency, whereas heart failure and particularly atrial fibrillation and its thromboembolic complications are the primary consequences of hyperthyroidism. In both cases, return to normal thyroid levels corrects the cardiac abnormalities caused by the dysthyroidism. Dysthyroidism (hypo- or hyperthyroidism) occurs in 10 to 20% of the patients treated with amiodarone for arrhythmia. Because of its potential seriousness, some clinical or laboratory tests are necessary before initiating treatment, and specific clinical surveillance should be scheduled, including laboratory tests.
Vinzio
S
S
Service de médecine interne et nutrition, Hôpital Hautepierre, av. Molière, 67098 Strasbourg cedex 67, France. stephane.vinzio@chru-strasbourg.fr
Brafin-Busch
M-S
MS
Schlienger
J-L
JL
Goichot
B
B
D000638:Amiodarone / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002320:Cardiovascular Physiological Phenomena; D003971:Diastole / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced / Q000503:physiopathology*; D007037:Hypothyroidism / Q000139:chemically induced / Q000503:physiopathology*; D013599:Systole / Q000502:physiology; D013963:Thyroid Hormones / Q000502:physiology
D000889:Anti-Arrhythmia Agents; D013963:Thyroid Hormones; D000638:Amiodarone