Papers regarding the impact of inappropriate thyroid hormone levels keep coming out.
It would be a miracle if endocrinologists showed any evidence of having read them. And incorporated the lessons into their practices.
Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis
Purpose: Thyroid hormones (THs) significantly affect the cardiovascular system. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker for diagnosing, evaluating, and predicting outcomes in heart failure (HF). This comprehensive review and meta-analysis aimed to investigate the effects of thyroid dysfunction (hypothyroidism and hyperthyroidism) on NT-proBNP levels.
Methods: Two investigators independently searched PubMed, Embase, Cochrane Library, and Web of Science databases for studies published from inception to July 31, 2022, without any restrictions on language.
Results: 21 studies were included. In participants without HF, NT-proBNP levels may be elevated in those with overt hyperthyroidism (standardized mean difference [SMD] 2.38, 95% confidence interval [CI]:1.0-3.76). Notably, among patients with preexisting HF, significantly higher NT-proBNP levels were found in patients with overt hyperthyroidism, overt hypothyroidism, or subclinical hypothyroidism than in euthyroid subjects (SMD [95%CI] = 0.31[0.01, 0.62], 0.32[0.08, 0.56], and 0.33[0.21, 0.46], respectively). Seven trials compared NT-proBNP levels in patients with thyroid dysfunction before and after therapy, and significant drops in NT-proBNP levels were observed in patients with hyperthyroidism (SMD [95%CI] = -1.53[-2.50, -0.55]) upon achieving a euthyroid state. In contrast, increased NT-proBNP levels were observed in hypothyroid patients after treatment (SMD [95%CI] = 1.07[0.28, 1.85]).
Conclusion: Thyroid dysfunction can significantly affect NT-proBNP levels, which may change upon achieving a euthyroid state. Notably, the effect of thyroid dysfunction on cardiac function may depend on the underlying cardiac status. Thus, timely recognition and effective treatment of cardiac symptoms in patients with thyroid dysfunction are mandatory because the prognosis of HF may be improved with appropriate treatment of thyroid dysfunction.
Thank you for posting. I love your comment 'It would be a miracle if endocrinologists showed any evidence of having read them. And incorporated the lessons into their practices'.
The evidence just keeps mounting. However, much of it has been known for actually a long time. See some of helvella many previous posts in this vein. Maybe it’s just me, I keep a eye on heart stuff because it’s particularly personal. No sign of GPs or specialisms outside endocrinology upping their knowledge of thyroid re: heart. Never mind endocrinology itself! I get the impression that even if they were required to keep up with developments; CPD Continuing Professional Development -Oops it’s a real thing they should be keeping up with and they clearly are not. Why not? It’s like everything else thyroid. It seems it’s of no importance. The only time they are concerned is if it looks like “patient has gone hyperthyroid” when really it’s a question of over or under medication! AND they have no idea why we are annoyed! The set up of the NHS and it’s ‘specialisms’ and none of them really speaking to each other, has been noted by many individuals and groups. Look at the rise (and sometimes falls) in the alternative or complementary medicines. The very necessity of this forum proves the inadequacy of the ‘system’.
From what I understand, the same divisions appear around the world.
And interesting that assembling "multidisciplinary teams" is so often mentioned in some areas of medicine. Where they actually get together, discuss, and plan.
But , it seems, very much not "simple" thyroid issues.
Probably scrambling this horribly, and grossly mis-understanding, but...
If a one-eyed man looks at a two-eyed man, he sees twice as much.
(The two-eyed man can only see the single eye of the one-eyed man. But the one-eyed man can see two eyes.)
I couldn't help this dwelling in my mind. Now imagine the doctors as the two-eyed. Having personal and professional eyes. And patients as one-eyed but seeing twice as much.
This time last year, a year on from having COVID-19, I was very fatigued and struggling to complete my tax return. My heart was racing and I felt breathless when standing for more than a few minutes, and my heart would race when sitting quietly in the evening. With the then spate of Omicron variant cases dying down, I plucked up courage to contact the surgery when I was also experiencing tachycardia in the mornings, after it having been an evening phenomenon. I was tested quite thoroughly, with my thyroid results being the only ones of concern. I re-did them, privately, during the evening when I was more likely to have tachycardia, and the results were more of a concern. Anyway, while being over-substituted my "heart failure test" was, in fact, OK:
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