Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine(336 views) Biondi B, Fazio S, Cuocolo A, Sabatini D, Nicolai E, Lombardi G, Salvatore M, Sacca L
Affiliations: Depts. Int. Med., Endocrinol., N., Univ. Federico II Medical School, Naples, Italy
Medicina Interna, Via Pansini 5, 80131 Naples, Italy
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Mandel, S. J., Brent, G. A., Larsen, P. R., Levothyroxine therapy in patients with thyroid disease (1993) Ann Intern Med, 119, pp. 492-50
Hennessey, J. V., Evaul, J. E., Tseng, Y. C., Burman, K. D., Wartofsky, L., L-Thyroxine dosage: A reevaluation of therapy with contemporary preparations (1986) Ann Intern Med, 105, pp. 11-15
Ross, D. S., Daniels, G. H., Gouveia, D., The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an out-patient endocrine clinic (1990) J Clin Endocrinol Metab, 71, pp. 764-769
Ross, D. S., Neer, R. M., Ridgway, E. C., Daniels, G. H., Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with l-thyroxine (1987) Am J Med, 82, pp. 1167-1170
Paul, T. L., Kerrigan, J., Kelly, A. M., Braverman, L. E., Baran, D. T., Long-term l-thyroxine therapy is associated with decreased hip bone density in premenopausal women (1988) JAMA, 259, pp. 3137-3141
Bonow, R. O., Udelson, J. E., Left ventricular diastolic dysfunction as a cause of congestive heart failure (1992) Ann Intern Med, 117, pp. 502-510
Kannel, W. B., Sorlie, P., Some health benefits of physical activity. The Framingham study (1979) Arch Intern Med, 139, pp. 857-861
Utiger, R. D., Subclinical hyperthyroidism - Just a low serum thyrotropin concentration or something more? (1994) N Engl J Med, 331, pp. 1302-1303
Sawin, C. T., Geller, A., Wolf, P. A., Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons (1994) N Engl J Med, 331, pp. 1249-1252
Merillon, J. P., Passa, P. H., Chastre, J., Gourgon, R., Left ventricular function and hyperthyroidism (1981) Br Heart J, 46, pp. 137-143
Parisi, A. F., Hamilton, B. P., Thomas, C. N., Mazzaferri, E. L., The short cardiac pre-ejection period: An index to thyrotoxicosis (1974) Circulation, 49, pp. 900-904
Cohen, M. V., Schulman, I. C., Spenillo, A., Surks, M. I., Effects of thyroid hormone on left ventricular function in patients treated for thyrotoxicosis (1981) Am J Cardiol, 48, pp. 33-38
Shafer, R. B., Bianco, J. A., Assessment of cardiac reserve in patients with hyperthyroidism (1980) Chest, 78, pp. 269-273
Forfar, J. C., Muir, A. L., Sawers, S. A., Toft, A. D., Abnormal left ventricular function in hyperthyroidism (1982) N Engl J Med, 307, pp. 1165-1170
Iskandrian, A. S., Rose, L., Hakki, A. -H., Segal, B. L., Kane, S. A., Cardiac performance in thyrotoxicosis: Analysis of 10 untreated patients (1983) Am J Cardiol, 51, pp. 349-352
Clifton, G. D., Harrison, M. R., DeMaria, A. N., Influence of beta-adrenergic blockade upon hemodynamic response to exercise assessed by Doppler echocardiography (1990) Am Heart J, 120, pp. 579-585
Martin III, W. H., Spina, R. J., Korte, E., Mechanisms of impaired exercise capacity in short duration experimental hyperthyroidism (1991) J Clin Invest, 88, pp. 2047-2053
Olson, B. R., Klein, I., Benner, R., Burdett, R., Trzepacz, P., Levey, G. S., Hyperthyroid myopathy and response to treatment (1991) Thyroid, 1, pp. 137-141
Twentyman, O. P., Disley, A., Gribbin, H. R., Alberti, K. G., Tattersfield, A. E., Effect of beta-adrenergic blockade on respiratory and metabolic responses to exercise (1931) J Appl Physiol, 51, pp. 788-793
Lundborg, P., str m, H., Bengtsson, C., Effect of beta-adrenoceptor blockade on exercise performance and metabolism (1981) Clin Sci, 61, pp. 299-305
Smith, R. S., Warren, D. J., Effect of acute oral beta-adrenergic blockade on muscle blood flow in man (1982) Cardiovasc Res, 16, pp. 205-208
Challiss, R. A. J., Hayes, D. J., Radda, G. K., A 31P-n. m. r. study of the acute effects of -blockade on the bioenergetics of skeletal muscle during contractien (1987) Biochem J, 246, pp. 163-172
Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine
To assess cardiac function and exercise tolerance in patients receiving long term TSH-suppressive therapy with levothyroxine (L-T4), we studied maximal exercise capacity with a bicycle ergometer and left ventricular function at rest and during physical exercise by radionuclide angiography. The evaluation was performed in 10 patients receiving L-T4 therapy (2.31 ± 0.13 μg/kg) for 5-9 yr, presenting with effort dyspnea and symptoms of adrenergic overactivity, and 10 matched control subjects. The patients were reassessed after 4 months of administration of the selective β-adrenergic blocker bisoprolol (4.25 ± 0.4 mg/day); L-T4 therapy remained unchanged. The results showed that at rest, left ventricular diastolic filling was impaired in the patients (P < 0.05), whereas systolic function was unaltered. During submaximal physical exercise, left ventricular ejection fraction increased in the controls from 58 ± 2% to 65 ± 2% (P < 0.001), whereas in the patients it fell from 63 ± 2% to 53 ± 2% (P < 0.01), mainly because of increased end-systolic left ventricular volume (P < 0.05). Exercise capacity was markedly reduced in the patients in terms of both peak workload (P < 0.001) and exercise duration (P < 0.001). β-Adrenergic blockade prevented both the fall in ejection fraction and the increase in end-systolic volume during exercise, and improved exercise tolerance. In conclusion, our data show that long term TSH-suppressive therapy with L-T4 is not as harmless as believed, because it may cause marked impairment of cardiac functional reserve and physical exercise capacity. Administration of a β-blocking drug for 4 months caused significant improvement of cardiac performance and exercise tolerance.
Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine
No results.
Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine
Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, Bengel F, Busemann Sokole E, Davies G, Dondi M, Edenbrandt L, Franken P, Kjaer A, Knuuti J, Lassmann M, Ljungberg M, Marcassa C, Marie PY, Mckiddie F, O'connor M, Prvuolovich E, Underwood R * 3. 0 T perfusion MR imaging(694 views) Rivista Di Neuroradiologia (ISSN: 1120-9976), 2004; 17(6): 807-812. Impact Factor:0.023 ViewExport to BibTeXExport to EndNote