Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

Objective: Hyperthyroidism has profound effects on the cardiovascular syste m, including reduced systemic vascular resistance (SVR) due to relaxation o f vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T-4) and tri-iodothyronine (T-3) estimat es within the reference range, in subjects with no obvious symptoms of hype rthyroidism. We measured haemodynamic changes (using impedance cardiography ) in subjects with endogenous subclinical hyperthyroidism in order to eluci date whether these patients had signs of excess thyroid hormone at the tiss ue level. Design: The patients were otherwise healthy women with a multinodular goitr e (n=6; age 47-81 years; serum TSH 0.006-0.090 mU/l and normal free T-4 and T-3 estimates), studied before and after normalisation of TSH (0.280-1.120 mU/l) by means of radioiodine treatment, and they were compared with 9 ove rt hyperthyroid patients (2 with multinodular goitre and 7 with Graves' dis ease) in the untreated state and after euthyroidism had been obtained. Results: Treatment of the subclinical hyperthyroid women resulted in 11% re duction in HR (P<0.02), 19% reduction in CO from (means<plus/minus>S.D.) 6. 93 +/-2.15 l/min to 5.58 +/-1.94 l/min (P<0.05), and 30% increase in SVR (P <0.02). Similar but more pronounced changes were seen in the hyperthyroid g roup: 17% reduction in HR, 25% reduction in CO and 46% increase in SVR (all at least P<0.05). Taking all 15 patients together, thyroid function (as me asured by free T-3 index (FT3I) or TSH) correlated significantly to the hae modynamic parameters as follows: the higher the thyroid function the lower the mean arterial pressure and SVR, and the higher the CO and central aorti c compliance (stroke volume/pulse pressure) (P<0.05). Plasma norepinephrine increased significantly after treatment of the overt hyperthyroid patients , whereas epinephrine did not change, and no changes were seen among subcli nical hyperthyroid patients. Conclusion: Treatment of endogenous subclinical hyperthyroidism resulted in significant changes in several haemodynamic parameters regarding the heart and the vascular system, compatible with some degree of excess tissue expo sure to thyroid hormones in the untreated state. Our data favour more aggre ssive treatment of these patients, and endogenous subclinical hyperthyroidi sm might be regarded as a mild form of hyperthyroidism.