A Role of Thyroid Hormones in Acute Myocardial Infarction: An Update

[helvella]

Yet again, cardiac people seem ahead of too many endocrinologists.

The last sentence of this abstract says so much:

The implications for the identification of the effects of thyroid disease on acute myocardial infarction include the observation that restoration of normal thyroid function repeatedly reverses abnormalities in cardiovascular hemodynamics.

Which should be an absolute fundamental of treatment of thyroid disorders. Yet, as we know all too well, inappropriate treatment seems very common. I wouldn't be at all surprised if the percentage who are under- or over-treated, and with an inappropriate choice of thyroid hormones, and poor dosing regimens, after diagnosis is greater than all the undiagnosed (but needing to be diagnosed) and well-treated by a large margin. It should come to be seen a major scandal.

Dose right and people get better. Isn't that the fundamental of all disease treated by medicines? (Rather than surgery, diet, physical measures, etc.)

That we see patient after patient who can't get the contributory factors (iron deficiency, multiple vitamin deficiencies, etc.) tested, let alone adequately treated, is horrific.

Just adding that they cannot hope to get the dosing right while they continue not to understand how our thyroid systems work. Which is very much where diogenes and associates come in.

Curr Cardiol Rev. 2022 Apr 28.

doi: 10.2174/1573403X18666220428121431. Online ahead of print.

A Role of Thyroid Hormones in Acute Myocardial Infarction: An Update

Rabia Rasool Rasool 1 , Ahsanullah Unar 2 , Tassadaq Hussain Jafar 2 , Ghulam Qadir Chanihoon 3 , Bismillah Mubeen 1

PMID: 35657286 DOI: 10.2174/1573403X18666220428121431

Abstract

Acute coronary syndrome is one of the commonest life-threatening illnesses. It encompasses the clinical spectrum of acute myocardial ischemia and includes unstable angina and acute myocardial infarction both with and without ST segment elevation. Acute coronary syndrome can be attributed to a significant hemodynamic insult that leads to atherosclerosis of the epicardial coronary arteries. The main causative risk factors, such as obesity, smoking, and alcohol intake, increase the burden of acute coronary syndrome. Owing to an increase in the utilization of antioxidants, the antioxidant capacity decreases with regard to the scavenging of lipid peroxides. Moreover, the thyroid hormones are important regulators of the expression of cardiac genes, and many of the cardiac manifestations of thyroid dysfunction are associated with alterations in triiodothyronine-mediated gene expression. Cardiovascular signs and symptoms of thyroid disease are among the most acute clinically relevant findings that occur in combination with both hypothyroidism and hyperthyroidism. By understanding the cellular mechanism of the action of thyroid hormones on the heart and cardiovascular system, it is possible to explain rhythm disturbances and alterations in cardiac output, blood pressure, cardiac contractility, and vascular resistance that result from thyroid dysfunction. Oxidative stress is thereby induced, together with a decrease in antioxidant capacity for overcoming oxidative stress, which leads to endothelial dysfunction, subsequent atherosclerosis, and, ultimately, acute myocardial infarction. The implications for the identification of the effects of thyroid disease on acute myocardial infarction include the observation that restoration of normal thyroid function repeatedly reverses abnormalities in cardiovascular hemodynamics.

Keywords: Cardiovascular; Hyperthyroidism Oxidative Stress.; Hypothyroidism; Thyroid Hormone.

Rest of paper behind a very expensive paywall:

pubmed.ncbi.nlm.nih.gov/356...

[Pearlteapot]

What bothers me is that getting to the right dose takes ages. I’m having palpitations, which I have never had before, knowing that my dose won’t be increased for another 3 weeks because titration has to be slow. People here seem to talk about palpitations as something normal but is it?! The effect of low t3 on the heart is built into the necessity for slow increases. It’s been really freaking me out. I’ve stopped wearing my Apple Watch or taking BP readings because it just provokes a panic attack. If my heart is fluttering I go to bed early and hope for the best until I can take my next dose in the morning.

[helvella Administrator Thyroid UK in reply to Pearlteapot]

I really do think that we have not properly and deeply investigated and understood how to manage dosing - in terms of the actual medicines (T4, T3, anything else and whatever combination), in terms of the times of day and how much, in terms of how quickly (or slowly) we need to make adjustments, not even in how best to manage testing.

It might be necessary to have very different approaches for different people.

My particular issue regarding the heart is a form of atrial fibrillation - which can change dramatically within seconds. Think 90 to 160 and back - in a hospital situation that change can occur faster than the screen refreshes! But my afib causes no pain, no palpitations, and much of time I don't even know it is happening. So very different to you.

[Pearlteapot in reply to helvella]

Do you think your aphib is the result of historic under dosing or is it a separate concurrent ailment ?

I suspect that the main difference from my experience is that I’m new to this and freaking out a lot , haven’t yet learned to recognise what matters and what doesn’t and when to be sanguine.

[helvella Administrator Thyroid UK in reply to Pearlteapot]

Honestly, I have no idea!

I do realise that I have had the possibility of very high heart rates going back many years. But I didn't then realise that they were unusually high - thought they were within everyone's experience. Never actually measured so I have no numbers.

[TSH110 in reply to Pearlteapot]

I used to think, oh well at least it’ll be fast as deaths go if I do keel over with a myocardial infarction! I had so many pain episodes that came to naught I just ignored it for 20 years.

I imagine any heart pains really ought to be thoroughly investigated, as they are not a good sign.

[helvella Administrator Thyroid UK in reply to TSH110]

I agree that pains should be investigated. But I don't have any heart pain at all!

[TSH110 in reply to helvella]

You must have a very flexible heart!

[TSH110]

I had heart pains for decades - I just ignored them they started in my 30’s 😳. I did get checked in my 40’s and there were abnormalities in heart trace and in one chamber, but I was told it was of no significance and down to women’s hormones. They got worse. I finally got diagnosed with thyroid disorder in my 50’s but my heart pains became even worse on Levothyroxine. They massively improved once I started NDT (self medicating) I haven’t had any for a long time now. It has to be lack of T3 that was causing them. If I hadn’t self medicated I wonder if I’d even be here now. Quite a few times I though this is it - curtains - the pains were so horrible. I was also given a pitifully low dose of Levothyroxine, because I had these darn pains, for months, greatly prolonging my suffering. If I could go from undetectable TSH to 110 in a week as I stared death in the face (and I had been yo-yoing from hyper to hypo for quite some time) surely I could have tolerated more than 25mcg as a starter dose (with some T3 , but let’s not get into the realms of fantasy) not left untitritated for three months. Once I saw the actual endocrinologist in person he at least got it up as fast as he could. A nurse pal told me I was lucky I didn’t have a massive heart attack with those sorts of changes . My heart has never been checked since. Apple Watch says it’s fine so I’m happy to believe it, & it’s probably more reliable than seeing a doctor and getting fobbed off.

I am astounded you have no indication that your heart’s throwing wobblies like that. Do you think your thyroid is the driver or it’s a strange variation? I don’t suppose there’s any way to tell save take some T3 and see if it normalises on that.

[Pearlteapot in reply to TSH110]

« Down to womenswear hormones’. That’s outrageous! What a story. Shocking.

Thé Guardian ran a piece on poor womens healthcare yesterday and is asking for readers experiences with endometriosis, fibroids, UTI. They seem unaware of the problems with thyroid treatment. Perhaps some members of this forum might like to correct that?

theguardian.com/lifeandstyl...

[Mlinde in reply to Pearlteapot]

Well incorrectly medicated hypothyroidism leads to raised cholesterol and high blood pressure (amongst all kinds of other symptoms), need I say more?

[helvella Administrator Thyroid UK in reply to TSH110]

I cannot believe it is only thyroid hormone. But cannot rule it out.

[TSH110 in reply to helvella]

You should deffo try some t3 I only needed a tiny amount to make a huge difference

[arTistapple]

I had a heart attack in 2002. No heart disease found. Pains from 1982. Investigated. Usual treatment for CHD. Diagnosis Coronary Spasm. Apparently it is now called vasospastic angina. However, although levothyroxine gets a bit of a bad press on here sometimes, it has removed my 3 or 4 bouts a day 24/7/365 days every year of angina pain, pretty full on for about 25 years. Prior to that I experienced it but less often and less extreme. Unfortunately other muscle problems have not improved so much and I am following everything on the forum with close interest. There was a bit of a flurry of interest in this condition - I think it got named Cardiac Syndrome X at the time. My sense is that there may be a significant minority suffering well before true CHD sets in, involving unnecessary expensive drug regimes. Under diagnosis of hypothyroidism is finally being suspected BUT people (as with myself) are being treated with the same old ‘heart’ drugs. I must say here I gave them up about 15 years ago. I fear people are not only being left to suffer debilitating symptoms but their so called subclinical state to go on far longer than necessary. Very powerful drugs are incorrectly prescribed which I am convinced further annoy the thyroid. Its my view people need hypothyroid treatment in a very individual holistic way. Something the NHS is clearly unable to do. This forum is screaming that fact. Optimal!?They may need more or less T4 or T3, NDT etc than others but until this is also recognised; and there is some research available (interpretation) hypothyroid patients continue to get very poor service. If thyroid patients were taken the time to be listened to - time invested getting it right first time - many people’s health, lives, quality of lives, livelihoods, doctor’s time and efforts and money could be saved.

[TSH110 in reply to arTistapple]

Perhaps you are a very efficient T4 to T3 converter and Levothyroxine was enough to allow for you to make adequate T3 to promote good heart health.

[arTistapple in reply to TSH110]

TSH110 I would love to think that I was a good converter but unfortunately other real quality of life issues remain significant. I am pretty sure thyroid is still at the root. Muscle problems, slowness, fatigue etc. Heart is the main thing that has truly improved and frankly since having those symptoms from 1982 it has been a total surprise. Doctor seems a bit non-plussed himself. Homeopaths (unlike doctors) work with a ‘hierarchy of symptoms’ which help guide the homeopath in the direction of ‘cure’. If the patients heart improved but say eczema was worse the homeopath knows the treatment is working. Simply, if the more external symptoms improve first, the homeopath will redo the case because the symptoms are going in the wrong direction! I am holding on to this theory at the moment. My heart was a major symptom and was unable to be treated by doctors but as most thyroid patients would agree, it is the sum total of the many varying and confusing symptoms experienced, which add up to the abysmal quality of life. I am off course grateful that the heart symptoms have improved so markedly but I consider myself very much in need of each and every person and their experience and knowledge on this forum. Hope this makes sense. Thank you.

[TSH110 in reply to arTistapple]

Yes I think someone’s only sone symptoms fully resolve others keep nagging away. Mine are the musculoskeletal ones they just will not go away. The brain fog, depression and heart ones resolved rapidly once I took NDT. I have the DIO2 gene combination for poor conversion but not the full one. It could explains why my relatives who took Levothyroxine all felt great on it and in a short time too but I was never at allWell on it even though the endocrinologist tried to get TSH well

below 1. 2years 9 months I decided to try NDT - it was a miracle for me gave me my life back.

I do hope you continue to see improvements - it’s not much fun feeling out of balance. ☘️🍀☘️

[arTistapple in reply to TSH110]

Exactly. Keep doing well and those pesky muscular things (both of us) get better with more tweaking.

[shaws Administrator]

To resolve my severe palpitations on levothyroxine it was T3 only that did the trick.

[Catseyes235 in reply to shaws]

You are living proof of ‘everyone’s different’. I take the most minimal dose of T3 (5 mcg tab - half each night and day) and feeling much better in so many areas! For me it’s the TSH issue and doctors using that and not actual symptoms that’s my bugbear. Not yet seen a great - and simple, article in why TSH should not always be the main determinant. (Daughter has the gene variant so pretty sure I do)

[shaws Administrator in reply to Catseyes235]

Well.....before I was diagnosed I had seen many medical professionals - I even had an operation on my throat to 'remove a web' something I didn't have. You are correct about clinical symptoms in that few doctors seem to know any at all.

Finally, through a question from someone I had a blood test for thyroid hormones. Doctor phoned after the blood test to state that I had no problems (I had been complaining for quite sometime of symptoms and feeling unwell).I had never heard of anything to do with the thyroid gland.

The doctor was unaware that there was a problem and had no notion of what a TSH of 100 indicated. I cannot state how ill I felt and it was only by chance (and the fact that I had internet connection - many people don't) - I got my feet on a ladder and that was Thyroiduk.org.uk.

I am now well and symptom-free.

[Catseyes235 in reply to shaws]

Yes I can date my thyroid problems and symptoms back to childhood and especially teenage years. Unfortunately thyroid problems seemed to be associated with middle aged women so I remained undiagnosed until 29 fluctuating from hyper to hypo every two years. I almost wish I had gone to a shrink having said if there wasn’t anything wrong I must be mad. I since found out that psychs were often aware of the ‘madness’ of thyroid symptoms. Luckily I was able to spot the signs when my daughter was a teenager.

[arTistapple in reply to Catseyes235]

I too complained in my teenage years and was told in no uncertain terms “No No No it can’t be that. It’s extremely rare!” After many years of self help books (they made a fortune out of me) counselling ditto, antidepressants; I had given in to the fact that it was a character flaw in myself. When I was finally diagnosed I had a glorious placebo few weeks, when I realised it was not actually the me inside my body that was the problem. No flaw in MY character! Yippee! It did not last long though. I read somewhere that just being overweight itself might be the cause. Symptoms started when I was about 7 and a half stone. What a downer! If they can’t get us one way, they will get us another! I will be 70 this year. So I reckon I have been undiagnosed for about 55 years and I bet this is NOT a record.

[Catseyes235 in reply to arTistapple]

I didn’t know much about thyroid and certainly wouldn’t have suggested it to my doctor - though in the 1960’s my aunt was diagnosed as hyper in her 50s and I was a very skinny teenager with very sweaty hands who approached her doctor because I ate like a horse and couldn’t put on weight. Dismissed as a teenager then as neurotic woman putting on weight in my twenties it’s like a history of dismissal!

[shaws Administrator in reply to Catseyes235]

Is it not surprising that it seems few GPs have much knowledge about diagnosing a patient, without blood tests as our old-fashioned doctors did before blood tests were introduced and they could diagnose upon our clinical symptoms alone and we were given a trial of NDTs (natural dessicated thyroid hormones) given since 1892 without the need of blood tests but doctor going by our clinical symptoms alone.

If patients could be diagnosed since 1892 why is there a failure today?

If you click on my name and it will take you to my 'page' in which I've put my history to be diagnosed

[shaws Administrator in reply to arTistapple]

I would definitely agree with your last sentence.

I think it is amazing that few doctors know how to diagnose/treat patients. It's like a mother who knows her child is unwell, just by their behaviour but that GPs seem to have no knowledge about one of the commonest autoimmune conditions.

You may have read this before as I have posted it:-

GP - Your TSH is too low - your T3 too high - your T4 too low.

Me: My TSH is low because I take T3 alone. My T4 is low because I take none. My T3 is higher as I take T3.

GP "but T3 converts to T4". No doctor it's the other way around i.e. T4 should convert to T3.

It's quite upsetting as we expect them to know the basics and they clearly do not.

Unexplained weight gain is due to our metabolism being so low because we're hypO not hypER.

What puzzles me the most is that they know no clinical symptoms of a common autoimmune condition.

I think many patients will be offered an anti-depressant rather than the Active Thyroid Hormone which is T3.

[arTistapple in reply to shaws]

Thank you for guiding me to your history. I am not familiar enough with this site yet. I have wondered about private messaging too but then there is nothing, as yet, that I feel I can’t say right here. Everyone is open and informative. Unlike perhaps the world outside this forum, where perhaps the medical profession might be highlighted. Whilst it can be scary reading people’s experiences, the strength of character on show here, evident in your story, is amazing and inspirational. Yesterday (after complaining to my surgery about stuff missing from my history/unable to access certain items) I got a phone call from the GP I have been most recently been working with. I was surprised he himself got back to me. Believe me this is one of the good guys. He spent half an hour going through stuff with me but in the end I still felt we were both basically speaking different languages. This is an inherent problem I find time after time. I have experience of working with doctors at all levels (worked in the NHS Personnel Dept for my sins) and one of the things I discovered was the very cloistered way in which they are educated/trained/socialised and I hate to add but many of them from very privileged backgrounds. The clout (power) of the consultant can be omnipotent. Whoever he/she is, is totally responsible for the culture of the department. “Power corrupts and absolute power corrupts absolutely”. However basic common sense can be absent. Whilst I suspect this view can be considered possibly more historical, it still exists and I think endocrinology re: thyroid, shows all the ‘symptoms’. The current nomenclature is ‘living in a bubble’. I think this, potentially, in many circumstances, creates a huge divide between doctor and patient. Whilst clearly this is not all doctors, the 7 minutes allocated per appointment puts severe stress on both patient and doctor for different reasons. Whoever can create an effective relationship in 7 minutes? Put that together with no experience of living the life of the hypothyroid. Gosh no wonder it is so difficult?!

[shaws Administrator in reply to arTistapple]

Thankfully, through this forum whatever is bothering us or we may not understand something, members will respond quickly and are helpful.