Acute Effects of Triiodothyronine (T 3 ) Replacement Therapy in Patients with Chronic Heart Failure and Low-T 3 Syndrome: A Randomized, Placebo-Controlled Study
Abstract
CONTEXT: Low-T(3) syndrome is a predictor of poor outcome in patients with cardiac dysfunction. The study aimed to assess the short-term effects of synthetic L-T(3) replacement therapy in patients with low-T(3) syndrome and ischemic or nonischemic dilated cardiomyopathy (DC). DESIGN: A total of 20 clinically stable patients with ischemic (n = 12) or nonischemic (n = 8) DC were enrolled. There were 10 patients (average age 72 yr, range 66-77; median, 25-75th percentile) who underwent 3-d synthetic L-T(3) infusion (study group); the other 10 patients (average age 68 yr, range 64-71) underwent placebo infusion (control group). Clinical examination, electrocardiography, cardiac magnetic resonance, and bio-humoral profile (free thyroid hormones, TSH, plasma renin activity, aldosterone, noradrenaline, N-terminal-pro-B-Type natriuretic peptide, and IL-6) were assessed at baseline and after 3-d synthetic L-T(3) (initial dose: 20 microg/m(2) body surface.d) or placebo infusion. RESULTS: After T(3) administration, free T(3) concentrations increased until reaching a plateau at 24-48 h (3.43, 3.20-3.84 vs. 1.74, 1.62-1.93 pg/ml; P = 0.03) without side effects. Heart rate decreased significantly after T(3) infusion (63, 60-66 vs. 69, 60-76 beats per minute; P = 0.008). Plasma noradrenaline (347; 270-740 vs. 717, 413-808 pg/ml; P = 0.009), N-terminal pro-B-Type natriuretic peptide (3000, 438-4005 vs. 3940, 528-5628 pg/ml; P = 0.02), and aldosterone (175, 152-229 vs. 231, 154-324 pg/ml; P = 0.047) significantly decreased after T(3) administration. Neurohormonal profile did not change after placebo infusion in the control group. After synthetic L-T(3) administration, left-ventricular end-diastolic volume (142, 132-161 vs. 133, 114-158 ml/m(2) body surface; P = 0.02) and stroke volume (40, 34-44 vs. 35, 28-39 ml/m(2) body surface; P = 0.01) increased, whereas external and intracardiac workload did not change. CONCLUSIONS: In DC patients, short-term synthetic L-T(3) replacement therapy significantly improved neuroendocrine profile and ventricular performance. These data encourage further controlled trials with more patients and longer periods of synthetic L-T(3) administration.
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Intravenous triiodothyronine produces similar vasodilatory effects in patients with chronic heart failure.
“Similar effects are observed when patients with chronic HF are treated with intravenous T 3 (18).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [18]
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References 32 · Cited by 279
- Authors
- Pingitore, A., Galli, E., Barison, A., Iervasi, A., Scarlattini, M., Nucci, D., L’Abbate, A., Mariotti, R., & Iervasi, G.
- Affiliations
- Istituto di Fisiologia Clinica (IT)
- University of Pisa (IT)
- Scuola Superiore Sant'Anna (IT)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-04
- Volume
- 93
- Issue
- 4
- Pages
- 1351-1358
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2162768237
- Cited by
- 279
- References
- 32
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 5 · 2023: 8 · 2022: 13 · 2021: 16 · 2020: 28 · 2019: 25 · 2018: 14 · 2017: 14 · 2016: 16 · 2015: 15 · 2014: 20 · 2013: 13 · 2012: 13
- FWCI
- 14.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- low T3 syndrome, chronic heart failure, dilated cardiomyopathy, ischemic cardiomyopathy, free T3, heart rate, norepinephrine, N-terminal pro-brain natriuretic peptide, aldosterone, plasma renin activity, interleukin-6, cardiac dysfunction, sympathetic activation, neurohormonal activation
- MeSH terms
- Aged, Cardiomyopathy, Dilated, Chronic Disease, Euthyroid Sick Syndromes, Female, Heart, Heart Failure, Humans, Male, Middle Aged, Thyroid Gland, Triiodothyronine, Hormone Replacement Therapy
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