title: Recombinant Human Thyrotropin Improves Endothelial Coronary Flow Reserve in Thyroidectomized Patients with Differentiated Thyroid Cancer.
abstract: The role of thyrotropin (TSH) on the cardiovascular system has been poorly investigated. It is unknown whether the changes in the vasculature associated with thyroid diseases result from altered thyroid hormone action or whether they are a consequence of a direct effect of TSH on endothelial cells. The present study was designed to evaluate the endothelial response of coronary flow to TSH in patients with differentiated thyroid cancer (DTC) without cardiovascular risk factors.
  
  
  
  The study population consisted of three men and seven women (Mage= 32.6 ± 8 years) who underwent total thyroidectomy for DTC. All were receiving therapy with L-thyroxine to maintain TSH within the reference range. No patient was obese, or had hypertension, diabetes, or dyslipidemia. Patients underwent standard echo-Doppler examination with evaluation of the coronary flow reserve (CFR) of the distal left anterior descending artery obtained by cold pressure test (CPT) before and 24 h after the second recombinant human TSH (rhTSH) injection.
  
  
  
  Left ventricular morphology and systolic and diastolic function were normal in all patients. Levels of thyroid hormones and thyroglobulin and antithyroglobulin antibodies did not differ significantly pre- versus post-rhTSH treatment, whereas TSH levels were higher after rhTSH administration. Blood pressure and heart rate were not affected by rhTSH. Coronary flow peak velocity at rest (22.3 ± 6 vs 23.2 ± 8.7; p = 0.66) did not differ between baseline and 24 h after rhTSH, while post-CPT velocity (29.3 ± 6.8 vs 34.4 ± 10.9; p < 0.05) and the CFR were higher after rhTSH administration (1.32 ± 0.2 vs. 1.53 ± 0.2; p < 0.01).
  
  
  
  rhTSH administration may improve the CFR after the non-pharmacological stressor CPT in DTC patients. The increase of coronary blood flow after rhTSH suggests that TSH may exert a protective effect on the coronary endothelium.
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Serena
authors: S
authors: Ippolito
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Renato
authors: R
authors: Ippolito
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Carmela
authors: C
authors: Peirce
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Roberta
authors: R
authors: Esposito
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Debora
authors: D
authors: Arpaia
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Ciro
authors: C
authors: Santoro
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Gilda
authors: G
authors: Pontieri
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Sara
authors: S
authors: Cocozza
authors: 2 Department of Advanced Biomedical Science, University of Naples Federico II , Naples, Italy .
authors: Maurizio
authors: M
authors: Galderisi
authors: 1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .
authors: Bernadette
authors: B
authors: Biondi
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002454:Cell Differentiation; D003131:Combined Modality Therapy / Q000009:adverse effects; D003326:Coronary Circulation / Q000187:drug effects*; D015150:Echocardiography, Doppler / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000378:metabolism / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000008:administration & dosage / Q000235:genetics / Q000378:metabolism / Q000627:therapeutic use*; D013974:Thyroxine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D013972:Thyrotropin; D013974:Thyroxine
keywords: cold pressure test; coronary flow reserve; differentiated thyroid cancer; endothelial cells; recombinant human thyroid stimulating hormone