Correlation exists between serum TSH and doppler echocardiography findings regarding diastolic dysfunction of left ventricle

 

Umesh Chandra Jha¹, Gangesh Kumar Gunjan^2*

 

 

Abstract              Background: Thyroid hormonal abnormalities and cardiovascular disease goes well beyond the risk of atherosclerosis in association with hypothyroidism and the risk of atrial fibrillation in persons with hyperthyroidism. Early identification of patients with sub-clinical hypothyroidism may lead to early treatment and thereby favourable effect on cardiovascular morbidity and mortality. Methods: Patients admitted in the department of Medicine, Darbhanga Medical College and Hospital with heart failure and diabetes mellitus who were willing to be enrolled in the study. Study Period: March 2017 to April 2018. Patients were initially selected on the basis of clinical suspicion. They were then subjected to thyroid function test (serum T3, T4, TSH estimation). Elevated TSH was the prime criterion in the diagnosis of hypothyroidism (serum TSH>6 mIU/L). Results: Out of the 50 hypothyroid patients with left ventricular diastolic dysfunction, we lost follow-up of 8 patients during our study before the first assessment. compares change in serum thyroid hormone levels in hypothyroid patients before and after treatment. Significant rise was observed in serum T3 level after 3 weeks and 3 months of treatment, from 0.85 + 0.48 to 1.10+ 0.41 and 2.14+ 0.62 respectively. Serum T4 level also showed significant rise after 3 weeks and 3 months of treatment with L-thyroxine from 43.64 + 16.37 to 52.12+ 14.73 and 92.13+ 18.35 respectively. Serum TSH level did not show a significant decrease after 3 weeks of treatment (44.90+ 25.19, P>0.05), but a significant decrease was seen after 3 months of treatment with L-thyroxine from 51.33 + 30.00 to 4.41+ 1.70. compares left ventricular diastolic function parameters in hypothyroid patients before and after treatment with l-thyroxine. After 3 weeks of treatment a significant increase was observed in E_max from 60.14 + 8.12 to 62.02+ 6.08, but there was no significant decrease in A_max value. However due to an increase in E_max, the E/Amax ratio was significantly increased from 0.75 + 0.08 to 0.81+ 0.09 after 3 weeks of treatment. No significant decrease was observed in IVRT and DT after 3 weeks. Conclusion: The probable mechanism of improvement of left ventricular diastolic dysfunction in the early part of thyroxine replacement therapy was due to biochemical changes i.e. induction of calcium ATPase b L-thyroxine in sarcoplasmic reticulum of myocardial cells.

Key Words: Cardiovascular disease, atrial fibrillation, hyperthyroidism, diabetes mellitus, L-thyroxine, left ventricular diastolic function.