Article Text

The non-thyroidal illness syndrome in acute coronary syndrome is associated with increased cardiac morbidity and mortality
  1. J Adawiyah1,
  2. A W Norasyikin1,
  3. N H Mat1,
  4. A S Shamsul1,2,
  5. K Nor Azmi
  1. 1Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
  2. 2Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Adawiyah Jamil, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia; adda_jamil{at}


Introduction The non-thyroidal illness syndrome (NTIS) or the sick euthyroid syndrome refers to abnormal changes in circulating thyroid hormones due to systemic illnesses. Thyroid hormones are pivotal in the regulation of normal cardiac functions. However, the effects of the NTIS on the heart in acute coronary syndrome (ACS) are still unclear.

Methods A 6-month prospective cohort study involving 85 patients admitted with ACS was carried out. TSH, FT4 and FT3 were assessed on days 1, 5 and 42. Antithyroid peroxidase antibodies, antithyroglobulin antibodies, fasting blood sugar, HbA1c and fasting serum lipid were obtained on admission. Mortality, functional status (Killip and New York Heart Association Classifications), arrhythmias and readmission rate were recorded.

Results The prevalence of NTIS was 53%. It was seen in 48% of unstable angina (UA), 54% of non-ST elevation myocardial infarction (NSTEMI) and 56% of ST elevation myocardial infarction (STEMI) patients. NTIS is associated with cardiovascular mortality, all-cause mortality, severe heart failure and a higher readmission rate. The levels of FT3 correlate with severity of myocardial damage as measured by CK and Troponin T. Lower TSH was seen in the non-survivors and in those with ventricular arrhythmias. The most common presentation of NTIS was low FT3 (43.5%), followed by low TSH (12.9%) and FT4 (4.7%). None of the predisposing factors analysed were associated with the development of NTIS.

Conclusions NTIS in patients with ACS is associated with increased cardiovascular mortality and morbidity, and affects UA, NSTEMI and STEMI equally.

  • Non-thyroidal illness syndrome (NTIS)
  • acute coronary syndrome

Statistics from


  • Funding Research grant of the Faculty of Medicine, National University of Malaysia (UKM), UKMMC, Jalan Yaacob Latif, 56000 Cheras, KL, Malaysia.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Research and Ethics Committee of the Faculty of Medicine, University Kebangsaan Malaysia.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.