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Echocardiographic Evaluation of Cardiac Changes in Patients with Hypothyroidism and the Response to Treatment
L N Begum1, M H Hoque, M Mahmood
1Dr Lutfun Nahar Begum, Assistant Professor of Cardiology, Cox's Bazar Medical College, Cox's Bazar, Bangladesh;
Insights
Hypothyroidism causes heart changes like thickened walls and reduced ejection fraction, but prompt treatment reverses these effects. Early diagnosis and therapy are crucial for managing cardiac complications in hypothyroid patients.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Thyroid hormone significantly influences cardiovascular function.
- Untreated hypothyroidism can lead to structural and functional heart changes.
- These cardiac manifestations are often reversible with appropriate thyroid hormone replacement therapy.
Purpose of the Study:
- To assess cardiac structural and functional alterations in hypothyroid patients.
- To evaluate the reversibility of these echocardiographic changes following treatment.
Main Methods:
- Prospective observational study involving 35 untreated hypothyroid cases and 35 controls.
- Echocardiography (2D, M-mode, Doppler) to measure left ventricular dimensions, wall thickness, ejection fraction, and mitral inflow patterns.
- Measurements were taken before and after >3 months of hypothyroidism treatment.
Main Results:
- Hypothyroid patients exhibited increased septal and posterior wall thickness, larger left ventricular internal dimensions (LVIDD, LVIDS), and reduced ejection fraction compared to controls.
- Mitral inflow showed higher A velocity and lower E/A ratio in hypothyroid cases.
- Treatment significantly reduced wall thickness and improved ejection fraction and mitral inflow parameters (increased E velocity, decreased A velocity, increased E/A ratio).
Conclusions:
- Hypothyroidism induces significant, reversible cardiac structural and functional changes.
- Early diagnosis and prompt treatment of hypothyroidism are essential to prevent and reverse cardiovascular complications.
- Echocardiography is a valuable tool for monitoring cardiac status in hypothyroid patients.
Abstract:
Thyroid hormone acts on heart and peripheral vascular system in multiple ways. Most of the cardiac manifestations are reversible with adequate and timely thyroid therapy. Echocardiographic changes are present in patients with untreated hypothyroidism and the changes are reversible with treatment. Aim of the study was to evaluate the structural and functional changes of the heart in hypothyroid patients and its response to treatment. This prospective observational study was performed in the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2012 to April 2013. The study included 35 cases and 35 control based on their thyroid hormonal status. The cases were previously untreated for hypothyroidism. By 2D and M-mode echocardiography LV septal wall and posterior wall thickness, LVIDD, LVIDS, LA and Aortic diameter and ejection fraction were measured. Mitral inflow pattern was observed through pulse wave Doppler and peak E velocity, a velocity and E/A ratio were noted. All the observations were noted both in cases and controls and in cases after normalization of hypothyroid status. Echocardiographic variables showed that septal wall and posterior wall thickness, LVIDD and LVIDS were higher in the cases than those in the control group. Left ventricular ejection fraction was lower in case group compared to control group. Of the mitral inflow parameters, a velocity was higher and E/A ratio lower in cases than those in control group. Following treatment of >3 months the septal wall and posterior wall thicknesses were reduced significantly (p<0.001 and p<0.001 respectively) and Left ventricular ejection fraction was also improved significantly (p<0.001) from its baseline status. Of the mitral inflow parameters, E-velocity was significantly increased, A-velocity significantly decreased and E/A ratio significantly increased from their baseline figures (p=0.016, p=0.032 and p<0.001 respectively). Cardiovascular complications of hypothyroidism increase the morbidity of the patients. Results of our study showed importance of early diagnosis and prompt treatment reversed the condition and that will diminish the extent of cardiac complications.
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