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Thyroid and the Heart: A Historical Perspective

  • José Augusto Sgarbi
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Abstract

It has long been known that thyroid hormones exert marked effects on the cardiac structure and function and that most of its clinical signs and symptoms occur as a consequence of thyroid hormone action in the heart and cardiovascular system (Klein and Ojamaa, N Engl J Med 344:501–509, 2001; Razvi et al., J Am Coll Cardiol 24:1781–1796, 2018). Since the first connection between the thyroid and the heart by Caleb Hillier Parry (Underwood 2:110, 1825), in 1825, many studies in humans and in animals have documented the heart abnormalities in consequence of thyroid hormone excess or deficiency. Typically, hyperthyroidism is often associated with increased cardiac contractility and cardiac output, decreased peripheral vascular resistance, systolic arterial hypertension, tachycardia, atrial fibrillation, left ventricular hypertrophy, and heart failure (Kahaly and Dillmann, Endocr Rev 26:704–728, 2005). On the other hand, hypothyroidism is associated with decreased cardiac contractility, increased peripheral vascular resistance, diastolic arterial hypertension, bradycardia, dilatation of all chambers, pericardial effusion, and heart failure (Kahaly and Dillmann, Endocr Rev 26:704–728, 2005). All of these abnormalities reverse to a condition close to normal after the appropriated treatment and reestablishment of the euthyroid state.

The mechanism responsible for these heart abnormalities is complex and involves the genomic and non-genomic effects of thyroid hormone on the heart myocyte (Klein and Ojamaa, N Engl J Med 344:501–509, 2001; Razvi et al., J Am Coll Cardiol 24:1781–1796, 2018; Kahaly and Dillmann, Endocr Rev 26:704–728, 2005; Dillmann, Am J Med 88:626–630, 1990). Several important proteins that interfere in the cardiac contractility are positively or negatively regulated by the action of thyroid hormones, such as α-myosin heavy chain (α-MHC), β-myosin heavy chain (β-MHC), sarcoplasmic reticulum calcium adenosine triphosphatase (SERCA2), and phospholamban (Dillmann, Am J Med 88:626–630, 1990; Lompré et al., J Biol Chem 259:6437–6446, 1984; Rohrer and Dillmann, J Biol Chem 263:6941–6944, 1988).

In this chapter, we shall be discussing the connection between the thyroid and the heart in a historical perspective, aiming to understand the linkages between the past and the present state of knowledge.

Keywords

Thyroid Thyroid hormone Hyperthyroidism Hypothyroidism Heart disease Heart failure 

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Authors and Affiliations

  • José Augusto Sgarbi
    • 1
  1. 1.Division of Endocrinology and Metabolism, Department of Internal MedicineFaculdade de Medicina de MariliaMaríliaBrazil

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