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Cited by 73Thyroid Disorders and TreatmentsCardiovascular and exercise physiologyCardiovascular Function and Risk Factors

Cardiovascular hemodynamics and exercise tolerance in thyroid disease

Kahaly, George J., Kampmann, Christoph, Mohr-Kahaly, Susanne·2002·Thyroid
DOI 10.1089/105072502760143845
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Abstract

The heart is an organ sensitive to the action of thyroid hormone, and measurable changes in cardiovascular performance are detected with small variations in thyroid hormone serum concentrations. Most patients with thyroid disease experience cardiovascular manifestations, and the most serious complications of thyroid dysfunction occur as a result of cardiac involvement. The increased metabolic state and oxygen consumption that occur in hyperthyroid patients require an increased supply of oxygen and removal of metabolic products from the periphery. This is accomplished by increasing the cardiac output to meet the needs of the periphery. Circulation time is decreased in hyperthyroid patients, and a lowered arterial resistance and increased venous resistance promote the return of blood to the heart. Thyroid hormones may significantly decrease the strength of respiratory and skeletal muscles and affect regulatory mechanisms of adaptation to incremental effort. In hyperthyroidism, cardiovascular exercise testing and analysis of respiratory gas exchange demonstrate low efficiency of cardiopulmonary function as well as impaired chronotropic, contractile, and vasodilatatory reserves, which are reversible when euthyroidism is restored. During exercise, the increment (delta) of minute ventilation (respiratory rate x tidal volume), and oxygen pulse (oxygen uptake per heart beat) are significantly lower in dysthyroidism versus euthyroidism. Especially in older patients with thyroid dysfunction, markedly reduced workload, delta ejection fraction, and delta heart rate, both at the anaerobic threshold as well as at maximal exercise, are observed. In thyrotoxicosis, mitochondria oxidative dysfunction during exercise mostly causes intracellular acidosis, whereas in hypothyroidism, inadequate cardiovascular support appears to be one of the principal factors involved. These abnormalities partly explain why subjects with dysthyroidism are intolerant to exertion. Thus, in thyroid disease, both cardiac structures and function may remain normal at rest, however impaired cardiovascular and respiratory adaptation to effort becomes unmasked during exercise.

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  • Hypothyroidism results in bradycardia, decreased cardiac systolic function and cardiac output, diastolic hypertension, increased vascular resistance, and higher total cholesterol and LDL cholesterol.

    “The cardiovascular effects of hypothyroidism usually predominate: hypothyroidism results in bradycardia, decreased cardiac systolic function and cardiac output, diastolic hypertension, increased vascular resistance, 106 and higher total cholesterol and LDL cholesterol.”

    From Hypothyroidism (2024) · cites this paper as [106]

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Authors
Kahaly, G. J., Kampmann, C., & Mohr-Kahaly, S.
Affiliations
University Medical Center of the Johannes Gutenberg University Mainz (DE)
ORCID
Venue
Thyroid
Publisher
SAGE Publications
Published
2002-06
Volume
12
Issue
6
Pages
473-481
ISSN
  • 1050-7256 (ISSN-L)
  • 1557-9077
DOI
10.1089/105072502760143845
OpenAlex
W2114559477
Cited by
73
References
45
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 3 · 2013: 6 · 2012: 3
FWCI
1.32
Type
journal article
Language
en
Open access
closed
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Thyroid (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
thyroid dysfunction, cardiovascular hemodynamics, exercise tolerance, hyperthyroidism, hypothyroidism, thyrotoxicosis, cardiac output, oxygen consumption, exercise testing, pulmonary gas exchange, anaerobic threshold, intracellular acidosis, chronotropic reserve
MeSH terms
Age Factors, Animals, Cardiovascular Physiological Phenomena, Exercise Test, Female, Heart, Humans, Male, Oxygen Consumption, Respiratory Physiological Phenomena, Stroke Volume, Thyroid Diseases, Triiodothyronine, Vascular Resistance, Exercise Tolerance, Rats

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