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The Role of Thyroid Hormones in Heart Failure
Catarina Vale1, João Sérgio Neves1,2, Madalena von Hafe1
1Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
Insights
Thyroid hormone (TH) modulation shows promise for treating heart failure, especially heart failure with preserved ejection fraction (HFpEF). Supplementation may improve cardiac function and patient outcomes in this challenging condition.
Area of Science:
- Cardiology
- Endocrinology
- Molecular Medicine
Background:
- Cardiovascular diseases, particularly heart failure, represent a major global health burden with high mortality.
- Heart failure with preserved ejection fraction (HFpEF) lacks effective treatments, and its prevalence varies significantly.
- Thyroid hormones (TH) critically regulate cardiovascular function, and alterations in TH levels are common in heart failure patients.
Purpose of the Study:
- To investigate the potential of thyroid hormones as a therapeutic target for heart failure.
- To explore the role of thyroid dysfunction and local cardiac hypothyroidism in heart failure pathophysiology.
- To review the evidence for TH supplementation in improving cardiac function and prognosis in heart failure.
Main Methods:
- Review of epidemiological studies on thyroid hormone levels and heart failure risk/prognosis.
- Analysis of experimental and clinical studies investigating TH supplementation in heart failure models and patients.
- Examination of the mechanisms underlying TH action in the cardiovascular system and their alterations in heart failure.
Main Results:
- Low thyroid hormone levels are associated with increased heart failure risk and poorer outcomes.
- Epidemiological data and small clinical studies suggest TH supplementation may benefit cardiac function in heart failure.
- Thyroid hormone levels can vary locally in the heart, potentially leading to cardiac hypothyroidism independent of serum levels.
Conclusions:
- Thyroid hormone modulation is a promising therapeutic strategy for heart failure.
- Further research is required to establish the safety and efficacy of TH supplementation in heart failure treatment.
- Understanding local TH regulation in the heart may offer new avenues for HFpEF therapy.
Abstract:
Cardiovascular diseases are the leading cause of death worldwide. Heart failure is the terminal manifestation of cardiovascular diseases, and its morbidity and mortality remain high. The prevalence of heart failure with preserved ejection fraction (HFpEF) among heart failure patients remains uncertain. However, recent studies have found that it ranged from 40 to 71%. There is still no effective treatment for HFpEF. Thyroid hormones (TH) have central regulatory actions in the cardiovascular system, particularly in the heart. Changes in plasmatic or tissue thyroid hormone levels are associated with significant alterations in cardiovascular function. A significant proportion of patients with heart failure presents some form of thyroid dysfunction including hypothyroidism, hyperthyroidism, and low T3 syndrome. Furthermore, thyroid hormones can vary at a local level independently of the serum TH levels. This may lead to local cardiac hypothyroidism in heart failure. Based on these findings and the role that TH play in cardiovascular regulation, they were proposed as a potential target for heart failure therapy. Several clinical and experimental studies have shown beneficial effects of TH supplementation. Data from epidemiological studies supports a higher risk of heart failure and a worse prognosis in heart failure patients with low levels of TH. In addition, animal studies and small clinical studies suggest that TH supplementation may improve cardiac function in heart failure. Although further studies are needed to evaluate the safety and efficacy of TH in this context, the available evidence suggests that TH modulation is a promising therapeutic approach to heart failure.
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