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Thyroid hormone and the cardiovascular system
Abstract
To understand the pathophysiology of thyroid heart disease, it is necessary to recognize that thyroid hormone has effects on both the peripheral circulation and the myocardium. One of the earliest responses to thyroid hormone administration is a decline in systemic vascular resistance and an increase in cardiac output and cardiac contractility. In many ways, this response is similar to the cardiovascular response to exercise and is associated with increased left ventricular work. The majority of cardiac adaptations to changes in thyroid function are physiologic; however, certain patients do demonstrate clinical evidence of cardiac disease. Atrial arrhythmias, limitations in exercise tolerance, and congestive heart failure are reported to occur as a result of hyperthyroidism and are more common in older patients. Thyroid hormone also plays an important role in the regulation of blood pressure. Diastolic hypertension is a common accompaniment of hypothyroidism. By understanding the mechanisms by which thyroid hormone affects both the peripheral circulation as well as the myocardium, it is possible to predict the clinical response to the treatment of various thyroid disease states.
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“Sympatho-adrenal stimulation could thus contribute to sustain BP levels during acute hypothyroidism as a possible mechanism counteracting the decrease in myocardial inotropism and cardiac output (4,14,15).”
From The Role of Thyroid Hormone in Blood Pressure Homeostasis: Evidence from Short-Term Hypothyroidism in Humans (2002) · cites this paper as [4]
In the citing paper
“A sensation of palpitation may stem from sinus tachycardia and/or increased cardiac contractility, both of which may have various causes: fever, anaemia, orthostatic hypotension, hyperthyroidism/ thyreotoxicosis, postmenopausal syndrome, pregnancy, hypoglycaemia, hypovolaemia, pheochromocytoma, arteriovenous fistula, postural orthostatic tachycardia syndrome, among others.31 -39”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [32]
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Triiodothyronine-mediated myosin heavy chain gene transcription in the heart
Danzi, S. E., Ojamaa, K., & Klein, I. L. (2003) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00860.2002 · Cited by 54
Self-citationThyroid hormone therapy in cardiovascular disease
Klemperer, J. D., Ojamaa, K., & Klein, I. L. (1996) · Progress in Cardiovascular Diseases · doi:10.1016/s0033-0620(96)80017-x · Cited by 53
Self-citationKhoury, S. F., Hoit, B. D., Davé, V., Pawloski-Dahm, C. M., Shao, Y., Gabel, M., Periasamy, M., & Walsh, R. A. (1996) · Circulation Research · doi:10.1161/01.res.79.4.727 · Cited by 52
Ojamaa, K., Samarel, A. M., Kupfer, J. M., Hong, C., & Klein, I. L. (1992) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1992.263.3.e534 · Cited by 52
Self-citationÖzcan, K. S., Osmonov, D., Toprak, E., Güngör, B., Tatlısu, A., Ekmekçi, A., Kaya, A., Tayyareci, G., & Erdinler, İ. (2014) · Cardiology Journal · doi:10.5603/cj.a2013.0108 · Cited by 50
Hypertension and hypothyroidism: results from an ambulatory blood pressure monitoring study
Kotsis, V., Alevizaki, M. K., Stabouli, S., Pitiriga, V. C., Rizos, Z., Sion, M., & Zakopoulos, N. A. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e328082e2ff · Cited by 49
Clinical review 36: Cardiovascular manifestations of endocrine disease
Klein, I. L., & Ojamaa, K. (1992) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.75.2.1639931 · Cited by 50
Self-citationWhen the storm passes unnoticed—A case series of thyroid storm
Ngo, S. Y. A., & Chew, H. C. (2007) · Resuscitation · doi:10.1016/j.resuscitation.2006.10.003 · Cited by 49
Gloss, B. R. (2001) · Endocrinology · doi:10.1210/en.142.2.544 · Cited by 49
Oral thyroid hormone pretreatment in left ventricular dysfunction
Şırlak, M., Yazıcıoğlu, L., İnan, M. B., Eryılmaz, S., TASOZ, R., Aral, A., & Özyurda, Ü. (2004) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2004.07.003 · Cited by 48
Novel Actions of Thyroid Hormone: The Role of Triiodothyronine in Cardiac Transplantation
Novitzky, D. (1996) · Thyroid · doi:10.1089/thy.1996.6.531 · Cited by 47
Cardiac Dysfunction Caused by Myocardium-Specific Expression of a Mutant Thyroid Hormone Receptor
Pazos-Moura, C. C., Abel, E. D., Boers, M.-E., de Moura, E. G., Hampton, T., Wang, J., Morgan, J. P., & Wondisford, F. E. (2000) · Circulation Research · doi:10.1161/01.res.86.6.700 · Cited by 46
Kurioka, Y., Inaba, M., Kawagishi, T., Emoto, M., Kumeda, Y., Inoue, Y., Morii, H., & Nishizawa, Y. (2001) · European Journal of Endocrinology · doi:10.1530/eje.0.1440099 · Cited by 44
Metadata
- Authors
- Klein, I.
- Affiliations
- Cornell University (US)
- Corresponding author
- Klein, Irwin
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1990-06
- Volume
- 88
- Issue
- 6
- Pages
- 631-637
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2073919574
- Cited by
- 370
- References
- 57
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 8 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 10 · 2016: 7 · 2015: 7 · 2014: 4 · 2013: 8 · 2012: 4
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r01hl041304-01)
- National Heart, Lung, and Blood Institute (HL-41304)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- thyroid hormones, hyperthyroidism, hypothyroidism, systemic vascular resistance, cardiac output, cardiac contractility, left ventricular work, atrial arrhythmias, exercise intolerance, congestive heart failure, diastolic hypertension, blood pressure regulation, myocardium
- MeSH terms
- Heart, Heart Diseases, Hemodynamics, Humans, Myocardial Contraction, Thyroid Diseases, Thyroxine, Triiodothyronine
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