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Stress echocardiography in hyperthyroidism.

G J Kahaly1, S Wagner, J Nieswandt

  • 1Department of Endocrinology/Metabolism, Gutenberg University Hospital, Mainz, Germany. kahaly@endokrinologie.klinik.uni-mainz.de

The Journal of Clinical Endocrinology and Metabolism
|July 15, 1999
PubMed
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Hyperthyroidism impairs cardiovascular function during exercise, reducing exercise capacity and cardiac reserves. These deficits are reversible with treatment, as shown by stress echocardiography.

Area of Science:

  • Cardiology
  • Endocrinology
  • Exercise Physiology

Background:

  • Hyperthyroidism frequently presents with exertional symptoms.
  • Stress echocardiography is a noninvasive tool to assess exercise capacity and left ventricular function.

Purpose of the Study:

  • To evaluate stress-induced cardiovascular function changes in hyperthyroidism using exercise echocardiography.
  • To compare cardiovascular responses during hyperthyroidism, propranolol treatment, and after euthyroidism restoration.

Main Methods:

  • Exercise echocardiography was performed on 42 untreated thyrotoxicosis patients and 22 healthy controls.
  • Patients underwent testing during hyperthyroidism, after propranolol, and after achieving euthyroidism.
  • A continuous ramp protocol ergometry was used, starting at 20 watts/min.

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Main Results:

  • Hyperthyroidism showed increased resting stroke volume index, ejection fraction, and cardiac index, but blunted exercise responses.
  • Maximal workload, heart rate, and stroke volume index changes were reduced in hyperthyroidism.
  • Systemic vascular resistance was reduced at rest in hyperthyroidism but did not decline further with exercise.

Conclusions:

  • Stress echocardiography reveals impaired chronotropic, contractile, and vasodilatory cardiovascular reserves in hyperthyroidism.
  • These impairments are reversible upon restoration of euthyroidism.
  • Propranolol treatment improved stroke volume index response during exercise.