Siva Sundar, A (2023) 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: Coronary artery disease is one of the leading causes of mortality in the world today-contributing to almost 13% of all the deaths annually. It is the most common cause of mortality in the noncommunicable disease category. There are numerous prognostic factors for ST elevation MI such as the TIMI risk score, the LV ejection fraction etc. The thyroid status of a patient at the time of presentation to the hospital also affects the recovery. Patients with a sick euthyroid state at the time of presentation have a higher risk of complications-including heart failure, ventricular arrhythmias and death. AIM AND OBJECTIVE: 1. To study the levels of TSH, fT3 and fT4 in patients presenting with ST elevation Myocardial Infarction. 2. To study the association, if any, between the presence of the Sick euthyroid state-characterised by reduced fT3 and normal TSH, fT4 levels and the incidence of MACE (Major adverse cardiac events), namely ventricular arrhythmias, cardiac failure and death. 3. To evaluate whether thyroid hormone profile can be used to predict prognosis in ST elevation myocardial infarction. MATERIALS AND METHOD: STUDY DESIGN: observational study. STUDY POPULATION: The study will be conducted among 75 patients admitted in Government Rajaji Hospital with history, clinical features and ECG changes of ST elevation Myocardial Infarction. INCLUSION CRITERIA: ❖ Age > 18 years. ❖ History of chest pain with ECG changes of ST elevation Myocardial Infarction. EXCLUSION CRITERIA: ❖ Patients presenting as Non ST elevation MI or unstable Angina. ❖ Known case of hypothyroidism/hyperthyroidism. ❖ Known case of any other endocrine disorder excluding Diabetes Mellitus. ❖ Known case of Chronic Kidney disease. ❖ Known case of Chronic Liver disease. ❖ Known case of malignancy. ❖ Patients with Renal failure. ❖ Patients taking amiodarone, steroids, propranolol, oral contraceptives. ❖ Patients who have received iodinated contrast in past week. RESULT: The cardiovascular system and the thyroid hormones are linked at multiple levels and in multiple ways. This study was conducted in 75 patients presenting with ST elevation Myocardial Infarction. Thyroid profile was done in all of them. The number of males in the study was 49 (65.3%) and their mean age was 52.6. The number of females was 26 (34.7%) and their mean age was 60.1. The total number of patients who were smokers is 46 (61.33%). Diabetics constituted 21.33% (16 patients) of the population and hypertension was seen in 24 patients (32%) The number of patients with a normal thyroid profile at the time of presentation was 40 and 13 of them were females. The number of patients with sick euthyroid state at the time of STEMI was 15 and 4 of them were females. The number of hypothyroid patients in the study was 10 and 5 of them were females. The number of patients who had atleast one major adverse cardiac events (MACE) is 19. Out of this, 13 patients belonged to the sick euthyroid group. 15 patients developed cardiac failure, 9 of them belonged to the sick euthyoid group. Ventricular arrhythmias were seen in 10 patients, with 8 of them in the sick euthyroid category. The number of deaths was 8 and 6 of the patients were part of the sick euthyroid group. The sick euthyoid state was seen in 33.3% of the study population and it was associated with an increased rate of MACE. There was a statistically significant association between the presence of the sick euthyroid state and the occurrence of cardiac failure, ventricular arrhythmias and death. CONCLUSION: Sick euthyroid is occurs in all age group and gender, not correlated with age, gender, DM and Hypertension. Sick euthyroid is well correlated with smoking, reduced fT3, TSH value and MACE. Sick euthyroid cases are significantly correlated (p < 0.05) with worse prognosis and have an increased risk of developing failure, arrhythmias and death. The sick euthyroid state is seen when a patient suffers from any serious illness. This study was done to look for any changes in the thyroid profile when a patient presents with an acute ST elevation myocardial infarction. Evaluate if the presence of any such changes has an effect on the course of the illness. When a patient presents with an acute myocardial infarction, some of them develop a sick euthyroid state. This may be part of the body’s compensatory mechanism to try and reduce the metabolic demand of the heart. The sick euthyroid state shows a positive association with the occurrence of MACE. STEMI patients who present with a sick euthyroid state have a worse prognosis and have an increased risk of developing failure, arrhythmias and death. They may need a longer duration of intensive care and close monitoring during follow-up.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | Reg.No.200120101523 |
| Uncontrolled Keywords: | Thyroid Profile, Prognostic Value, ST Elevation Myocardial Infarction. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Nov 2022 17:36 |
| Last Modified: | 22 Mar 2024 02:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/20922 |
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