The influence of thyroid function on hemodynamic balance, heart rate and rhythm is well known by every clinical practitioner. But which is the real impact of different conditions, both clinical and subclinical, on cardiovascular risk? What are the evidence based data supporting thyroid responsibility? Are they weak or strong? This is the issue of the presentation.
Il rischio tromboembolico nelle patologie arteriose e venose della donna 3
Distiroidismi e rischio cardiovascolare
1. Distiroidismi e rischio
cardiovascolare
Plinio Fabiani
Medicina Interna - Portoferraio
Hotel Borgo degli Olivi
Vignale Riotorto
27 febbraio 2016
IL RISCHIO CARDIOVASCOLARE IN MEDICINA INTERNA
4. T3 eT4
• LaT4 alcuni effetti non genomici
• Largamente considerata pro-ormone
• La maggior parte dellaT4 (90%) è convertita aT3 per 5’
mono deiodinazione nel fegato, reni e muscolo
scheletrico.
• LaT3 attraverso la circolazione generale è disponibile per
tessuti e organi che possono contare in maniera esclusiva o
preponderante sullaT3 serica, come il cuore
14. Klein I, Ojamaa K. N Engl J Med 2001;344:501-509.
Sites of Action ofTriiodothyronine on Cardiac Myocytes.
15. Rilasciamento isovolumetrico in rapporto
allo stato tiroideo
controllo
Ipotiroidismo subclinico
Ipotiroidismo
Ipertiroidismo IT +
propranololo
Eutiroidismo
Post-terapia
16. Pericardial effusion secondary to hypothyroidism is a diagnostic challenge for physicians
because of discrepancy between clinical symptoms and amount of pericardial effusion.
Formos J Endocrin Metab 2009; 1: 29-32
17. Punti Chiave
• La disfunzione della tiroide può danneggiare il
cuore e l’apparato cardiovascolare
• Malattie croniche, incluse quelle cardiche
possono causare la sindrome da bassaT3 (low
T3 syndrome)
• NYHA 3 e 4 la prevalenza della LT3S è
aumentata
• Bassi valori diT3 sono associati a prognosi
sfavorevole, indipendentemente dalla causa
21. Aritmie e ipertiroidismo
• Tachicardia sinusale: la più frequente nei giovani e nei
soggetti altrimenti sani
• Fibrillazione atriale: aumenta la frequenza con l’età,
specie nell’ipertiroidismo subclinico.
22. Aritmie e ipotiroidismo
• The electrocardiogram in hypothyroidism is characterized by
sinus bradycardia, low voltage, and prolongation of the
action potential duration and the QT interval.The latter, in
turn, predisposes patients to ventricular arrhythmias.There
are case reports of patients with acquired torsades de pointes
that completely resolved with thyroid hormone therapy.1
24. J Clin Endocrinol Metab, July 2014, 99(7):2372–2382
563,700 Patients included in analysis, contributing 2,902,568 person-years and mean follow-up time of 5 years
25. Circulation. 2012;126:1040-1049
25 390 participants with 216 248 person-years of follow-up were supplied from 6
prospective cohorts in the United States and Europe.
26. Hazard Ratios for Coronary Heart Disease Mortality According toThyroid-Stimulating Hormone Levels
Endocrine, Metabolic & Immune Disorders - DrugTargets, 2013, 13, 4-12
cohort studies with a systematic review and pooled individual data from 70’061
participants (USA, South America, Europe, Asia,Australia
27. Endocrine, Metabolic & Immune Disorders - DrugTargets, 2013, 13, 4-12
• L’associazione fra ipertiroidismo subclinico e fibrillazione atriale incidente ha
confrontato 7901 pazienti eutiroidei e 810 con ipertiroidismo subclinico di 5
coorti da USA, Europa e Australia.
• Rischio di FA incidente in Ipertiroidismo Subclinico:
• HR 1.63 (95% CI 1.10-2.41) forTSH 0.10-0.44 mIU/L
• HR 2.54 (95% CI 1.08-5.99) forTSH < 0.10 mIU/L
• (p per trend 0.02).
29. BMJ 2012;345:e7895 doi: 10.1136/bmj.e7895
(Published 27 November 2012)
586 460 individuals in the study population
(mean (SD) age 50.2 (16.9) years, 39% men
31. Better Adherence to Antithyroid Drug Is AssociatedWith
Decreased Risk of Stroke in Hyperthyroidism Patients
Int J Clin Pract. 2015;69(12):1473-1485
32. Fatal and non-fatal cardiovascular events
Estimated Enrollment: 540
May 2014: Study Start Date:
November 2016: (final data collection date for primary outcome measure)
February 2017: Estimated Study Completion Date:
This clinical trial should definitively clarify whether thyroxine treatment for SCH provides
benefits that are relevant for patients.This trial will provide strong evidence with the
potential to improve clinical practice, reduce health care costs and promote healthy ageing
of older adults.