Evaluation of Cardiovascular Function in Primary Hypothyroidism utilising Echocardiography

Rajendran, M (2007) Evaluation of Cardiovascular Function in Primary Hypothyroidism utilising Echocardiography. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: The thyroid gland maintains the level of metabolism in the tissues that is optimal for their normal function. Thyroid hormones stimulate oxygen consumption of most of the cells in the body, and regulates carbohydrate and lipid metabolism. Thyroid function is regulated by Thyroid stimulating hormone (TSH). Hypothyroidism, a state of deficient thyroid hormones, may be result of many etiologies. Hypothyroidism can affect all organ systems, including cardiovascular system. The cardiovascular manifestations can be like systolic dysfunction, diastolic dysfunction, pericardial effusion, ECG changes , coronary artery disease and congestive cardiac failure. These dysfunctions can also be contributed by hypertension, hypercholesterolemia which are part of hypothyroidism. Some studies suggest that abdominal aortic atheroscerosis can occur even in mild hypothyroidism. An understanding of pathophysiology of cardiovascular changes in hypothyroidism enables prevention, early diagnosis and prompt intervention to control complications. Also the presence of cardiovascular complications may necessitate institution of thyroid hormone replacement in patients of asymptomatic hypothyroidism. This study is undertaken at Stanley Medical College, Chennai to evaluate the cardiovascular changes that accompany various grades of hypothyroidism. AIM OF THE STUDY: To study the cardiovascular changes in patients with overt primary hypothyroidism utilizing echocardiography. MATERIALS AND METHODS: This study was conducted in patients with hypothyroidism who attended the endocrinology department in Stanley Medical College Hospital, Chennai, during the period November 2005 to July 2006. Patients who were newly diagnosed to have overt hypothyroidism were taken up for the study. Patients thus selected were divided into three categories according to the level of thyroid stimulating hormone (TSH) as follows: (i) Mild hypothyroidism (< 20 mIU/ml), (ii) Moderate hypothyroidism (20 – 50 mIU/ml), (iii) Severe hypothyroidism (> 50 mIU/ml). Exclusion Criteria - The following patients were excluded from the study: • Patients with known primary cardiac disease. • Patients with chronic pulmonary disease, severe anemia, diabetes mellitus and chronic kidney disease. • Patients who were taking drugs that alter the cardiovascular functions like amiadarone, Beta blockers and calcium channels blockers etc. • Patients of hypothyroidism who were receiving thyroid replacement therapy. • Patients with subclinical hypothyroidism ( Normal T4 with elevated TSH). SUMMARY: 1. A total of 40 patients were analyzed. There were 30 females and 10 males. Mean age of presentation was 32.5 years. 2. There were 15 % Mild hypothyroidism,42.5% Moderate hypothyroidism and 42.5 % Severe hypothyroidism patients. 3. 40% of patients were overweight and 12.5 % of patients were obese. 4. Hypercholesterolemia occurred in 45 % and Hypertension occurred in 37.5 %. 5. Chest xray was normal in all patients. 6. Commonest ECG abnormality noted was sinus bradycardia. 7. In echocardiographic study, interventricular septal wall and left ventricular posterior wall hypertrophy noted in 50 % and 35 % of patients respectively. 8. Diastolic dysfunction was observed in 32.5 % ( E/A ratio < 1). 9. Grade 1 systolic dysfunction was noted only in one patient(2.5 %). 10. Pericardial effusion occurred in 3 patients (7.5 %). 11. Dilated left ventricle / left atrium or regional wall motion abnormalities were not found in any patient. CONCLUSION: Echocardiography is easily performed, noninvasive, safe, reproducible and accurate in assessment of cardiac function in hypothyroidism. • Hypertrophy of interventricular septum and left ventricular posterior wall was the commonest abnormality observed in echocardiography. • Diastolic dysfunction occurred in significant number of hypothyroid patients. • The cardiovascular changes were more marked in severe hypothyroidism.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cardiovascular Function ; Primary Hypothyroidism ; Echocardiography.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 04:26
Last Modified: 24 Mar 2018 06:40
URI: http://repository-tnmgrmu.ac.in/id/eprint/6454

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