Clinical studyAssociation between increased levels of reverse triiodothyronine and mortality after acute myocardial infarction☆
Section snippets
Methods
On arrival in the coronary care unit at Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden, a sample of venous blood was drawn from 385 consecutive patients with myocardial infarction. All samples were obtained before reperfusion therapy, if any. Diagnosis of myocardial infarction was established by an elevation of serum creatine kinase level and its subunit MB, in addition to characteristic chest pain or typical electrocardiographic changes. Blood samples were centrifuged
Results
Twenty-nine patients (9%) died within the first month and 53 patients (16%) within the first year. Patients who died during the first year were older (mean age, 75 ± 10 years vs. 68 ± 12 years), had larger infarctions (estimated by peak levels of creatine kinase-MB fraction), and were more likely to have had renal dysfunction and a history of prior heart failure or angina (Table 1).
Among all 331 patients, the mean serum concentration levels were as follows: T3, 1.8 ± 0.4 nmol/L; reverse T3,
Discussion
Normal thyroid homeostasis is altered in patients with myocardial infarction; the point of equilibrium appears to be changed and the thyroid hormone axis appears to be downregulated, such that serum levels of T3, the active hormone, were somewhat reduced in our patients, whereas levels of the inactivated metabolite reverse T3 and the weakly active precursor hormone free T4 were increased. Normally, this would result in a feedback increase in TSH levels to restore T3 levels; however, TSH levels
Acknowledgements
We are grateful to Susanne Bergman, Diana Karlsson, Hildegard Magnusson, and Gun Wesley for their skillful assistance, to Hanna Svensson for statistical assistance, to Niklas Hammar, PhD, for statistical advice, and to Nancy Pedersen, PhD, and Sarah Wamala, PhD, for their helpful comments.
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Supported by grants from the Ansgarius Foundation, Belvén Foundation, Karolinska Institutet, and Swedish Medical Research Council (Project 19X-11629).