25 research outputs found
Evaluation of cardiac ischaemia in cardiac asymptomatic newly diagnosed untreated patients with primary hypothyroidism
BACKGROUND: Hypothyroidism is regarded as a risk factor for coronary artery disease. Possible factors involved in this association are hyperlipidaemia and hypertension, both occurring with increased frequency in hypothyroid patients. The aim of our study was to evaluate signs/symptoms of cardiac ischaemia in untreated hypothyroid patients without angina pectoris, since this has never been performed before.
METHODS: 51 consecutive cardiac asymptomatic patients (mean age 47, range 22 to 86 years) were studied by dobutamine stress echocardiography and bicycle ergometry.
RESULTS: Mean values of body mass index, resting heart rate and blood pressure were 28.5 kg/m2, 68 beats/min and 129/81 mmHg, respectively. Median TSH was 51.9 mU/l, mean FT4 7.3 +/- 2.9 pmol/l (mean +/- SD), TT3 1.6 +/- 0.6 nmol/l and total cholesterol was 5.8 +/- 1.6 mmol/l. None of the patients had symptoms of angina pectoris during dobutamine stress echocardiography or bicycle ergometry and no evidence of myocardial ischaemia was demonstrated. Exercise tolerance, assessed by dividing the maximum achieved workload by the target performance (depending on body height, sex and age), was diminished in 38% of patients, and significantly related to the degree of hypothyroidism.
CONCLUSION: No angina pectoris or cardiac ischaemia at exercise or stress was found in cardiac asymptomatic hypothyroid patients. The precise role of hypothyroidism as a risk factor for coronary artery disease should be further elucidated
Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care
Postpartum thyroiditis is a syndrome of transient or permanent thyroid
dysfunction occurring in the first year after delivery and based on an
autoimmune inflammation of the thyroid. The prevalence ranges from 5-7%.
We discuss the role of antibodies (especially thyroid peroxidase
antibodies), complement, activated T cells, and apoptosis in the outbreak
of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an
acute phase of autoimmune thyroid destruction in the context of an
existing and ongoing process of thyroid autosensitization. From pregnancy
an enhanced state of immune tolerance ensues. A rebound reaction to this
pregnancy-associated immune suppression after delivery explains the
aggravation of autoimmune syndromes in the puerperal period, e.g., the
occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve
due to autoimmune thyroiditis is increasingly recognized as a serious
health problem. 1) Thyroid autoimmunity increases the probability of
spontaneous fetal loss. 2) Thyroid failure due to autoimmune
thyroiditis-often mild and subclinical-can lead to permanent and
significant impairment in neuropsychological performance of the offspring.
3) Evidence is emerging that as women age subclinical hypothyroidism-as a
sequel of postpartum thyroiditis-predisposes them to cardiovascular
disease. Hence, postpartum thyroiditis is no longer considered a mild and
transient disorder. Screening is considered
Cardiac and metabolic effects in patients who present with a multinodular goitre
Twenty-six consecutive patients who presented with clinically euthyroid
multinodular goitre were studied for an overnight fasting serum lipid
profile and 24 h Holter monitoring. Mean serum TSH was 0.6 +/- 0.4 vs 2.4
+/- 1.3 mU/l (p < 0.0001) and mean TT3 2.4 +/- 0.4 vs 2.0 +/- 0.5 nmol/l
(p = 0.009) in patients vs controls (n = 15) while mean FT4 was not
different from controls. Total serum HDL, LDL cholesterol and
triglycerides were lower in patients but creatinine, ferritin and SHBG
levels did not differ between patients and controls. The 24-hour
ambulatory continuous ECG recordings did not demonstrate significant
differences in mean, minimal and maximal heart rate between the study and
the control group. Nocturnal heart rate, measured between 23.00 and 06.00
hours, also showed no differences between the two groups. Atrial
fibrillation was absent in both the study and the control group. Premature
atrial and ventricular complexes occurred equally frequently in both
groups. Comparison of patients with a serum TSH below 0.4 mU/l (n = 11)
and patients with a TSH above 0.4 mU/l revealed no differences. In
conclusion, in consecutive patients who present with multinodular goitre,
effects were found on the lipid profile, but not on the heart. It is
argued that in this type of patients, cardiac effects depend on the degree
of subclinical hyperthyroidism
Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?
OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish
and Surinam-Asian migrants with type 2 diabetes mellitus in the
Netherlands as compared with Europeans. METHODS: In a consecutive
case-control study, 59 Turkish and 62 Surinam-Asian patients were compared
with 185 Europeans referred to a diabetes clinic for treatment of type 2
diabetes in the period 1992 to 1998. Main outcome measures were ischaemic
heart disease and its associated risk factors. RESULTS: The prevalence of
ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher
(29%) in the Surinam-Asians compared with the Europeans (23%). The Turks
(52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than
the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5
(p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29
+/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and
used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found
in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of
the Europeans. In univariate analysis ischaemic heart disease was related
to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin,
OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01.
Other variables were not related to ischaemic heart disease. Multivariate
analysis in a model with ethnicity and smoking showed significant
relations between ischaemic heart disease and Turkish ethnicity, OR 0.19
(0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p =
0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2
diabetes mellitus in different ethnic groups results in a significant
difference in incidence of ischaemic heart disease. The most remarkable
finding is a low incidence of ischaemic heart disease in the Turkish
patients with type 2 diabetes, independent of smoking. The high prevalence
of ischaemic heart disease in young migrant Asians with diabetes is
confirmed
Decrease of free thyroxine levels after controlled ovarian hyperstimulation
Controlled ovarian hyperstimulation could lead to opposing effects on
thyroid function. Therefore, in a prospective study of 65 women undergoing
controlled ovarian hyperstimulation, thyroid hormones, T4-binding
globulin, TPO antibodies, gonadotropins, estradiol, and PRL were measured
before and after controlled ovarian hyperstimulation. After ovarian
stimulation (mean +/- SE of mean): free T4 decreased, 14.4 +/- 0.2 vs.
12.9 +/- 0.2 pmol/L (P < 0.0001); thyroid-stimulating hormone increased,
2.3 +/- 0.3 vs. 3.0 +/- 0.4 mU/L (P < 0.0001); T4-binding globulin
increased, 25.2 +/- 0.7 vs. 33.9 +/- 0.9 mg/L (P < 0.0001); total T4
increased, 98.1 +/- 2.3 vs. 114.6 +/- 2.5 nmol/L (P < 0.0001); total T3
increased, 2.0 +/- 0.04 vs. 2.3 +/- 0.07 nmol/L (P < 0.0001); TPO
antibodies decreased, 370 +/- 233 U/mL vs. 355 +/- 224 U/mL (P < 0.0001);
LH decreased, 8.1 +/- 1.1 vs. 0.4 +/-0.1 U/L (P < 0.0001); FSH did not
change, 6.5 +/- 0.6 vs. 7.9 +/- 0.9 U/L (P = 0.08); human CG increased, <2
+/- 0.0 vs. 195 +/- 16 U/L (P < 0.0001); estradiol increased, 359.3 +/-
25.9 pmol/L vs. 3491.8 +/-298.3 pmol/L (P < 0.0001); and PRL increased,
0.23 +/- 0.02 vs. 0.95 +/- 0.06 U/L (P < 0.0001). Because low maternal
free T4 and elevated maternal thyroid-stimulating hormone levels during
early gestation have been reported to be associated with impaired
psychomotor development in the offspring, our findings indicate the need
for additional studies in the children of women who where exposed to high
levels of estrogens around the time of conception
Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?
textabstractOBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish
and Surinam-Asian migrants with type 2 diabetes mellitus in the
Netherlands as compared with Europeans. METHODS: In a consecutive
case-control study, 59 Turkish and 62 Surinam-Asian patients were compared
with 185 Europeans referred to a diabetes clinic for treatment of type 2
diabetes in the period 1992 to 1998. Main outcome measures were ischaemic
heart disease and its associated risk factors. RESULTS: The prevalence of
ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher
(29%) in the Surinam-Asians compared with the Europeans (23%). The Turks
(52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than
the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5
(p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29
+/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and
used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found
in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of
the Europeans. In univariate analysis ischaemic heart disease was related
to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin,
OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01.
Other variables were not related to ischaemic heart disease. Multivariate
analysis in a model with ethnicity and smoking showed significant
relations between ischaemic heart disease and Turkish ethnicity, OR 0.19
(0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p =
0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2
diabetes mellitus in different ethnic groups results in a significant
difference in incidence of ischaemic heart disease. The most remarkable
finding is a low incidence of ischaemic heart disease in the Turkish
patients with type 2 diabetes, independent of smoking. The high prevalence
of ischaemic heart disease in young migrant Asians with diabetes is
confirmed