B. Biondi et al., IMPAIRED CARDIAC RESERVE AND EXERCISE CAPACITY IN PATIENTS RECEIVING LONG-TERM THYROTROPIN SUPPRESSIVE THERAPY WITH LEVOTHYROXINE, The Journal of clinical endocrinology and metabolism, 81(12), 1996, pp. 4224-4228
To assess cardiac function and exercise tolerance in patients receivin
g long term TSH-suppressive therapy with levothyroxine (L-T-4), we stu
died maximal exercise capacity with a bicycle ergometer and left ventr
icular function at rest and during physical exercise by radionuclide a
ngiography. The evaluation was performed in 10 patients receiving L-T-
4 therapy (2.31+/-0.13 mu g/kg) for 5-9 yr, presenting with effort dys
pnea and symptoms of adrenergic overactivity, and 10 matched control s
ubjects. The patients were reassessed after 4 months of administration
of the selective beta-adrenergic blocker bisoprolol (4.25+/-0.4 mg/da
y); L-T-4 therapy remained unchanged. The results showed that at rest,
left ventricular diastolic filling was impaired in the patients (P <0
.05), whereas systolic function was unaltered. During submaximal physi
cal exercise, left ventricular ejection fraction increased in the cont
rols from 58+/-2% to 65+/-2% (P <0.001), whereas in the patients it fe
ll from 63+/-2% to 53+/-2% (P <0.01), mainly because of increased end-
systolic left ventricular volume (P <0.05). Exercise capacity was mark
edly reduced in the patients in terms of both peak workload (P <0.001)
and exercise duration (P <0.001). beta-Adrenergic blockade prevented
both the fall in ejection fraction and the increase in end-systolic vo
lume during exercise, and improved exercise tolerance. In conclusion,
our data show that long term TSH-suppressive therapy with L-T-4 is not
as harmless as believed, because it may cause marked impairment of ca
rdiac functional reserve and physical exercise capacity. Administratio
n of a beta-blocking drug for 4 months caused significant improvement
of cardiac performance and exercise tolerance.