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Circulation, Vol 87, 1435-1441, Copyright © 1993 by American Heart Association
R Polikar, AG Burger, U Scherrer and P Nicod
Cardiovascular manifestations are a frequent finding in hyperthyroid and
hypothyroid states. In this review, potential mechanisms by which thyroid
hormones may exert their cardiovascular effects and pathophysiological
consequences of such effects are briefly discussed. Two major concepts have
emerged about how thyroid hormones exert their cardiovascular effects.
First, there is increasing evidence that thyroid hormones exert direct
effects on the myocardium, which are mediated by stimulation of specific
nuclear receptors, which in turn leads to specific mRNAs production.
Furthermore, there is some evidence that thyroid hormones may also activate
extranuclear sites and may directly alter plasma membrane function. Second,
thyroid hormones interact with the sympathetic nervous system by altering
responsiveness to sympathetic stimulation presumably by modulating
adrenergic receptor function and/or density. Pathophysiological
consequences of such direct and indirect thyroid hormone effects include
increased myocardial contractility and relaxation that may be related to
stimulation by T3 of specific myocardial enzymes. However, when left
ventricular hypertrophy occurs in association with hyperthyroidism, it may
be related to either direct thyroid hormone-induced stimulation of
myocardial protein synthesis or to thyrotoxicosis-induced increases in
cardiac work load. Although hyperthyroidism generally has little or no
effect on mean arterial blood pressure, hypothyroidism is often associated
with increases in diastolic blood pressure that are reversible after
hormone substitution and may be mediated in part by sympathetic activation.
Moreover, there is increasing evidence that thyroid hormones have direct
chronotropic effect on the heart that are independent of the sympathetic
nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The thyroid and the heart
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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