Indian Journal of Clinical Biochemistry

, Volume 33, Issue 2, pp 222–228 | Cite as

Linear Analysis of Autonomic Activity and Its Correlation with Creatine Kinase-MB in Overt Thyroid Dysfunctions

  • Manisha Mavai
  • Yogendra Raj Singh
  • R. C. Gupta
  • Sandeep K. Mathur
  • Bharti Bhandari
Original Article
  • 40 Downloads

Abstract

Autonomic activity may be deranged in thyroid dysfunctions and may lead to cardiovascular morbidity and mortality. Myopathy is a common manifestation in thyroid disorders and may be associated with raised serum creatine kinase (CK). We hypothesized that cardiovascular abnormality in thyroid dysfunction may manifest as raised CK-MB. This study was designed to investigate the correlation of CK and its isoform CK-MB with thyroid profile and linear parameters of heart rate variability (HRV). The study was conducted on 35 hypothyroid and hyperthyroid patients each, and 25 age-matched healthy controls. Autonomic activity was assessed by simple short term 5-min HRV. Biochemical evaluation of serum thyroid profile, CK-NAC and CK-MB were estimated in all the subjects. Our results demonstrated low HRV in hypo- as well as hyperthyroid patients. We observed significantly higher serum CK levels in hypothyroid patients when compared to hyperthyroids and controls. However, no significant differences were observed in CK-MB levels in the three groups. Significant positive correlation of CK with TSH and negative correlation with some HRV parameters (LF power, HF power, total power, SDNN, RMSSD) was observed in hypothyroid patients. Whereas correlation of CK-MB with thyroid profile as well as HRV parameters was non-significant in all the groups. Based on the CK and CK-MB findings and their correlation, we conclude that the cardiovascular changes seen in thyroid dysfunctions may primarily be due to autonomic imbalance without apparent cardiac muscle involvement. Whereas, raised CK levels indicate predominantly skeletal muscle involvement in hypothyroid patients.

Keywords

Heart rate variability Hypothyroidism Hyperthyroidism Creatine kinase Correlation 

Notes

Compliance with Ethical standards

The study was commenced after obtaining ethical clearance from the Institutional Ethics Committee and has followed all Ethical standards.

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354–81.CrossRefGoogle Scholar
  2. 2.
    McMillan DE. Interpreting heart rate variability sleep/wake patterns in cardiac patients. J Cardiovasc Nurs. 2002;17:69–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Osman F, Gammage MD, Franklyn JA. Thyroid disease and its treatment: short-term and long-term cardiovascular consequences. Curr Opin Pharmacol. 2001;1:626–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Galetta F, Franzoni F, Fallahi P, Rossi M, Carpi A, Rubello D, et al. Heart rate variability and QT dispersion in patients with subclinical hypothyroidism. Biomed Pharmacother. 2006;60:425–30. doi: 10.1016/j.biopha.2006.07.009.CrossRefPubMedGoogle Scholar
  5. 5.
    Mahajan A, Chowdhury V, Dhanwal D, Jain A, Lal R. Evaluation of autonomic functions in subclinical hypothyroid and hypothyroid patients. Indian J Endocrinol Metab. 2013;17:460–4. doi: 10.4103/2230-8210.111642.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Omerbegovic M. Analysis of heart rate variability and clinical implications. Med Arh. 2009;63:102–5.PubMedGoogle Scholar
  7. 7.
    Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Recent Prog Horm Res. 2004;59:31–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Tietz NW. Text book of clinical chemistry. Philadelphia: WB Saunders Co.; 1986. p. 678–86.Google Scholar
  9. 9.
    Siegel AJ, Silverman LM, Evans WJ. Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners. JAMA. 1983;250:2835–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Beyer IW, Karmali R, Demeester-Mirkine N, Cogan E, Fuss MJ. Serum creatine kinase levels in overt and subclinical hypothyroidism. Thyroid. 1998;8:1029–31. doi: 10.1089/thy.1998.8.1029.CrossRefPubMedGoogle Scholar
  11. 11.
    Tietz NW. Clinical Guide to laboratory tests. Philadelphia: WB Saunders Co; 1995. p. 95.Google Scholar
  12. 12.
    Syamsunder AN, Pal GK, Pal P, Kamalanathan CS, Parija SC, Nanda N. Association of sympathovagal imbalance with cardiovascular risks in overt hypothyroidism. North Am J Med Sci. 2013;5:554–61. doi: 10.4103/1947-2714.118921.CrossRefGoogle Scholar
  13. 13.
    Kaminski G, Makowski K, Michałkiewicz D, Kowal J, Ruchala M, Szczepanek E, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid. 2012;22:454–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Syamsunder AN, Pal P, Pal GK, Kamalanathan CS, Parija SC, Nanda N, et al. Decreased baroreflex sensitivity is linked to the atherogenic index, retrograde inflammation, and oxidative stress in subclinical hypothyroidism. Endocr Res. 2017;42:49–58. doi: 10.1080/07435800.2016.1181648.CrossRefPubMedGoogle Scholar
  15. 15.
    Inukai T, Takanashi K, Kobayashi H, Fujiwara Y, Tayama K, Aso Y, et al. Power spectral analysis of variations in heart rate in patients with hyperthyroidism or hypothyroidism. Horm Metab Res. 1998;30:531–5. doi: 10.1055/s-2007-978927.CrossRefPubMedGoogle Scholar
  16. 16.
    Xing H, Shen Y, Chen H, Wang Y, Shen W. Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism. Chin Med J (Engl). 2001;114:906–8.Google Scholar
  17. 17.
    McGrowder DA, Fraser YP, Gordon L, Crawford TV, Rawlins JM. Serum creatine kinase and lactate dehydrogenase activities in patients with thyroid disorders. Niger J Clin Pract. 2011;14:454–9. doi: 10.4103/1119-3077.91755.CrossRefPubMedGoogle Scholar
  18. 18.
    Mushtaq S, Tilak M, Rashid MR, Shinde S, Phalak P. Biochemical evaluation of myopathy in patients of hypothyroidism. Indian J Basic Appl Med Res. 2014;3:364–72.Google Scholar
  19. 19.
    Wan Nazaimoon WM, Siaw FS, Sheriff IH, Faridah I, Khalid BA. Serum creatine kinase: an adjunct biochemical index of subclinical thyrotoxicosis? Ann Clin Biochem. 2001;38:57–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Ranka R, Mathur R. Serum creatine phosphokinase in thyroid disorders. Indian J Clin Biochem. 2003;18:107–10. doi: 10.1007/BF02867676.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Prakash A, Lal AK, Negi KS. Serum creatine kinase activity in thyroid disorders. JK Sci. 2007;9:25–6.Google Scholar
  22. 22.
    Sinclair C, Gilchrist JM, Hennessey JV, Kandula M. Muscle carnitine in hypo- and hyperthyroidism. Muscle Nerve. 2005;32:357–9. doi: 10.1002/mus.20336.CrossRefPubMedGoogle Scholar
  23. 23.
    Khaleeli AA, GriYth DG, Edwards RHT. The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle. Clin Endocrinol. 1983;19:365–76.CrossRefGoogle Scholar
  24. 24.
    Lima JG, Nóbrega LH, Nóbrega ML, Santos Júnior AC, Fernandes Fda C, Mesquita DJ, et al. Influence of thyroid function in CPK serum levels. Arq Bras Endocrinol Metabol. 2012;56:190–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Duyff RF, Van den Bosch JV, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000;68:750–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gunduz H, Arinc H, Yolcu M, Akdemir R, Kanat M, Uyan C. A case of hypothyroidism mimicking acute coronary syndrome. Int J Cardiovasc Imaging. 2006;22:141–5. doi: 10.1007/s10554-005-9011-5.CrossRefPubMedGoogle Scholar

Copyright information

© Association of Clinical Biochemists of India 2017

Authors and Affiliations

  1. 1.Department of PhysiologyAll India Institute of Medical SciencesJodhpurIndia
  2. 2.Department of PhysiologyMGMCJaipurIndia
  3. 3.Department of EndocrinologySMS Medical CollegeJaipurIndia

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