Cardiovascular Disorders in Thyrotoxicosis of Various Origins: Optimization of Treatment Approaches

Abstract

We have found that in patients with overt hyperthyroidism, pathological remodeling of the left ventricle was found in 30.1 % of cases. The most common type of pathological remodeling was eccentric left ventricular hypertrophy (18.2 %). In non-immune pathogenesis of hyperthyroidism, concentric left ventricular remode- ling formed more often. In patients with overt thyrotoxicosis, formation of all types of left ventricular pathological remodeling was associated with male gender, age older than 44 years, the presence of systolic hypertension, duration of the disease with the lack of stable compensation of hyperthyroidism for more than 20 months. In patients with overt thyrotoxicosis, atrial fibrillation, pulmonary hypertension, heart failure occurs much more frequently than in patients who had subclinical hyperthyroidism (16.5 and 7 %; 40 and 32 %; 8.6 and 4.5 %, respectively). Both overt and subclinical thyrotoxicosis led to the development of endothelial dysfunction, the incidence and severity of which was greater in autoimmune origin of thyrotoxicosis (impaired endothelium-dependent vasodilation in the immune origin was observed in 79 % of patients, with non-immune origin — in 13.3 % of cases, the level of von Willebrand factor was higher in the immune origin of hyperthyroidism in 53 % of patients, with non-immune origin — in 20 %, and its average level was within the normal range in this group). Selecting thyrostatic (mercazolilum or propitsil) and beta-blockers (selective or non-selective) is not a factor determining the risk of thyrotoxic cardiomyopathy and inverse dynamics of its manifestations. Inclusion in the therapy of angiotensin converting enzyme inhibitors can reduce the severity of left ventricular hypertrophy, dilatation of the left atrium, left ventricular diastolic dysfunction and endothelial dysfunction.

Keywords

• thyrotoxicosis
• cardiovascular complications