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Review
. 2014 Aug;127(8):691-8.
doi: 10.1016/j.amjmed.2014.03.009. Epub 2014 Mar 22.

Thyroid and the heart

Ira Martin Grais  1 , James R Sowers  2
Affiliations
Review

Thyroid and the heart

Ira Martin Grais et al. Am J Med. 2014 Aug.

Abstract

Thyroid hormones modulate every component of the cardiovascular system necessary for normal cardiovascular development and function. When cardiovascular disease is present, thyroid function tests are characteristically indicated to determine if overt thyroid disorders or even subclinical dysfunction exists. As hypothyroidism, hypertension, and cardiovascular disease all increase with advancing age, monitoring of thyroid-stimulating hormone, the most sensitive test for hypothyroidism, is important in this expanding segment of our population. A better understanding of the impact of thyroid hormonal status on cardiovascular physiology will enable health care providers to make decisions about thyroid hormone evaluation and therapy in concert with evaluating and treating hypertension and cardiovascular disease. The goal of this review is to access contemporary understanding of the effects of thyroid hormones on normal cardiovascular function and the potential role of overt and subclinical hypothyroidism and hyperthyroidism in a variety of cardiovascular diseases.

Keywords: Atrial fibrillation; Cardiac output; Coronary artery disease; Heart failure; Peripheral vascular function; Thyroid dysfunction.

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Figures

Figure 1
Figure 1. Each component of the flow law is influenced by thyroid hormone
MAP = mean arterial pressure, RAP = right atrial pressure, Q. = Cardiac Output, TPR = total peripheral resistance. The Poiseuille-Hagan Law demonstrates how small changes in arteriolar radius lead to geometric changes in arteriolar resistance. R= resistance; r = radius; # = (η = dynamic fluid viscosity; Δ = change; X = distance in direction of flow; ∏ = mathematical constant Pi).
Figure 2
Figure 2. Thyroid hormone effects on the heart
T3 = triiodothyronine; TR = thyroid hormone receptors; cAMP = cyclic AMP, PKC = protein kinase C; PI3-K = phosphoinositol 3-kinase; Akt = protein kinase B; (p) mTOR = phosphorylation of mammalian target of rapamycin; (p)ERK = phosphorylation of extracellular-signal-regulated kinases; SERCa2+= sarcoplasmic reticulum Ca2+; Na = sodium; K-ATPase = potassium adenosine triphosphatase; MHCα = myosin heavy chain alpha; MHCβ = myosin heavy chain alpha beta; ANP = atrial natriuretic peptide
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