A Study on Thyroid Profile and Its Prognostic Value in Patients Presenting with ST Elevation Myocardial Infarction

Lavanya, N (2015) A Study on Thyroid Profile and Its Prognostic Value in Patients Presenting with ST Elevation Myocardial Infarction. Masters thesis, Madurai Medical College, Madurai.

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Abstract

BACKGROUND AND OBJECTIVES: The cardiovascular system and the thyroid gland are linked to each other at multiple ways and in many ways. Hypothyroidism and hyperthyroidism are both associated with an increased risk of coronary artery disease. The sick euthyroid state or the low free T3 state is characterised by a normal level of TSH, normal free T4, a reduced free T3 and elevated reverse T3.This state is usually seen when the patient suffers from any serious illness. This study is done to analyse the effects of the sick euthyroid state on the outcome of patients admitted with ST elevation Myocardial infarction. METHODS: 75 patients admitted at Government Rajaji Hospital with ST elevation Myocardial Infarction in the period between September 2013 and August 2014 were included in the study. ST elevation myocardial infarction was diagnosed with the help of history, clinical examination and a 12-lead ECG. Thyroid profile was done for all the 75 patients at the time of admission. Patients with prior history of any endocrine disorder (excluding diabetes mellitus), chronic kidney disease, chronic liver disease, oral contraceptive use, malignancy were excluded from the study. The study population was divided into 3 groups based on the thyroid profile- those with a normal thyroid profile, those with a sick euthyroid state and hypothyroid patients. All 3 groups were followed up till discharge or death and the incidence of MACE (major adverse cardiac events-cardiac failure, ventricular arrhythmias and death) was studied. The sick euthyroid group and the normal thyroid profile groups were compared in terms of in-hospital short term outcome. RESULTS: All the patients were followed up till discharge or death. Out of the 75 patients included in the study, 52 had a normal thyroid status, 8 were hypothyroid and 15 had a sick euthyroid state. Cardiac failure (66.67%, p<0.0001), ventricular arrhythmias (33.33%, p<0.012) and death (75%, p<0.0002) were found to occur more frequently in the sick euthyroid group. The incidence of MACE was 80% in the sick euthyroid group (12 out of 15 patients) with a p value of <0.0001. INTERPRETATION AND CONCLUSION: Patients with ST elevation Myocardial Infarction who have a sick euthyroid state at the time of presentation have a poor prognosis. They have a higher incidence of mortality, cardiac failure and ventricular arrhythmias.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Sick euthyroid state ; ST elevation myocardial infarction ; MACE-major adverse cardiac events ; cardiac failure ; prognosis.
Subjects: MEDICAL > General Medicine
Depositing User: Punitha K
Date Deposited: 18 May 2018 18:52
Last Modified: 18 May 2018 18:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/7882

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