{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:05:52Z","timestamp":1773248752124,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T00:00:00Z","timestamp":1588032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Thyroid hormones (TH) affect cardiac function through effects on cardiac contractility and systemic vascular resistance. While TH replacement for patients with hypothyroidism might be necessary for restoration of cardiac output after an acute myocardial infarction (AMI), it could theoretically lead to excessively rapid restoration of the metabolic rate. The appropriate management of hypothyroidism in patients with AMI is unknown. We describe the practice patterns in the management of hypothyroidism in the setting of AMI as well as patients\u2019 clinical outcomes. Material and Methods: Retrospective study of patients that were admitted to a tertiary care hospital with AMI and newly diagnosed or uncontrolled hypothyroidism (TSH \u2265 10 mIU\/L) between 2011\u20132018. Eligible patients were identified using diagnosis codes for AMI and laboratory values, followed by medical record review. We categorized patients according to treatment status with TH and by degree of hypothyroidism. Clinical outcomes included: 30-day mortality\/readmission, bleeding, stroke, arrhythmia, sudden cardiac death, and new or worsening heart failure. Summary statistics and group comparisons are presented. Results: Sixty-four patients were included, their median age was 64 years and 61% (n = 39) were women. Most of the patients (59%) had a documented history of hypothyroidism. Of these, all were restarted on levothyroxine (LT4) during the index admission when compared to patients without a history of hypothyroidism, of which 54% received LT4 treatment (p = 0.001). The median TSH in those treated with LT4 was higher (25 mIU\/L) when compared to those who were not (12 mIU\/L), (p = 0.007). Patients who received intravenous LT4 had higher TSH levels and other variables suggesting worse clinical presentation, but these differences were not statistically significant. No statistically significant differences were noted on clinical outcomes according to LT4 treatment status. Conclusion: A history of hypothyroidism and the degree of TSH elevation seem to guide the management of hypothyroidism in patients with AMI. The clinical effect of correcting hypothyroidism in this setting requires further evaluation.<\/jats:p>","DOI":"10.3390\/medicina56050214","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T05:05:32Z","timestamp":1588050332000},"page":"214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of Hypothyroidism in Patients with Acute Myocardial Infarction"],"prefix":"10.3390","volume":"56","author":[{"given":"Danielle","family":"Eagan","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, &amp; Metabolism, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela","family":"Spencer-Bonilla","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spyridoula","family":"Maraka","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health care System, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naykky","family":"Singh Ospina","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, &amp; Metabolism, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.amjmed.2014.03.009","article-title":"Thyroid and the heart","volume":"127","author":"Grais","year":"2014","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12020-019-02050-4","article-title":"Novel uses of thyroid hormones in cardiovascular conditions","volume":"66","author":"Razvi","year":"2019","journal-title":"Endocrine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1089\/thy.2007.0033","article-title":"Treatment of hypothyroidism in elderly patients and in patients with cardiac disease","volume":"17","year":"2007","journal-title":"Thyroid"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ning, Y., Cheng, Y.J., Liu, L.J., Sara, J.D., Cao, Z.Y., Zheng, W.P., Zhang, T.S., Han, H.J., Yang, Z.Y., and Zhang, Y. (2017). What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med., 15.","DOI":"10.1186\/s12916-017-0777-9"},{"key":"ref_5","first-page":"394","article-title":"Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality: An Individual Participant Data Analysis from Nine Prospective Cohort Studies","volume":"25","author":"Rodondi","year":"2010","journal-title":"J. Gen. Intern Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1530\/EJE-11-0062","article-title":"Thyroid hormone and recovery of cardiac function in patients with acute myocardial infarction: A strong association?","volume":"165","author":"Lymvaios","year":"2011","journal-title":"Eur. J. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jjcc.2018.02.013","article-title":"Low T3 syndrome improves risk prediction of in-hospital cardiovascular death in patients with acute myocardial infarction","volume":"72","author":"Su","year":"2018","journal-title":"J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E1274","DOI":"10.1503\/cmaj.190395","article-title":"Canadian Task Force on Preventive Health C: Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care","volume":"191","author":"Birtwhistle","year":"2019","journal-title":"CMAJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1001\/jama.2018.13770","article-title":"Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis","volume":"320","author":"Feller","year":"2018","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S2213-8587(16)30276-5","article-title":"Levothyroxine overuse: Time for an about face?","volume":"5","author":"Maraka","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"l4892","DOI":"10.1136\/bmj.l4892","article-title":"Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: Longitudinal study","volume":"366","author":"Thayakaran","year":"2019","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1056\/NEJMoa1603825","article-title":"Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism","volume":"376","author":"Stott","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1089\/thy.2006.0235","article-title":"Serum, TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999\u20132002)","volume":"17","author":"Aoki","year":"2007","journal-title":"Thyroid"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1001\/archinte.160.4.526","article-title":"The Colorado thyroid disease prevalence study","volume":"160","author":"Canaris","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1159\/000499751","article-title":"Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis","volume":"8","author":"Mendes","year":"2019","journal-title":"Eur. Thyroid J."},{"key":"ref_16","first-page":"e26919","article-title":"Thyroid Hormone Profile in Patients with Acute Coronary Syndrome","volume":"17","year":"2015","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"dgz143","DOI":"10.1210\/clinem\/dgz143","article-title":"Sample Timing, diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 study","volume":"105","author":"Razvi","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1001\/archinte.162.12.1388","article-title":"Rapid down-regulation of thyroid hormones in acute myocardial infarction\u2014Is it cardioprotective in patients with angina?","volume":"162","author":"Friberg","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.amjcard.2018.12.020","article-title":"Usefulness of Triiodothyronine Replacement Therapy in Patients With ST Elevation Myocardial Infarction and Borderline\/Reduced Triiodothyronine Levels (from the THIRST Study)","volume":"123","author":"Pingitore","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2016.10.039","article-title":"Non-thyroidal illness syndrome in patients with cardiovascular diseases: A systematic review and meta-analysis","volume":"226","author":"Wang","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"808","DOI":"10.4158\/EP13460.OR","article-title":"A diagnostic scoring system for myxedema coma","volume":"20","author":"Popoveniuc","year":"2014","journal-title":"Endocr. Pract."},{"key":"ref_22","unstructured":"(1989\u20132019). JMP, SAS Institute. version 15.0 Pro; Software for Data Analysis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1089\/thy.2014.0028","article-title":"Guidelines for the treatment of hypothyroidism: Prepared by the american thyroid association task force on thyroid hormone replacement","volume":"24","author":"Jonklaas","year":"2014","journal-title":"Thyroid"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/j.2042-7174.2012.00205.x","article-title":"Management of long-term hypothyroidism: A potential marker of quality of medicines reconciliation in the intensive care unit","volume":"20","author":"Barrett","year":"2012","journal-title":"Int. J. Pharm. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/BF03348548","article-title":"Evaluation of pituitary-thyroid axis response to acute myocardial infarction","volume":"8","author":"Mancini","year":"1985","journal-title":"J. Endocrinol. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1159\/000176862","article-title":"Changes in thyroid hormone parameters after acute myocardial infarction","volume":"86","author":"Eber","year":"1995","journal-title":"Cardiology"},{"key":"ref_27","first-page":"688","article-title":"Thyroid hormone profile in acute coronary syndromes","volume":"87","author":"Pimentel","year":"2006","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1002\/clc.23062","article-title":"Thyroid stimulating hormone elevation as a predictor of long-term mortality in patients with acute myocardial infarction","volume":"41","author":"Seo","year":"2018","journal-title":"Clin. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.mce.2014.04.010","article-title":"Cardioprotective effects of thyroid hormones in a rat model of myocardial infarction are associated with oxidative stress reduction","volume":"391","author":"Tavares","year":"2014","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/s10495-015-1204-3","article-title":"Thyroid hormones improve cardiac function and decrease expression of pro-apoptotic proteins in the heart of rats 14 days after infarction","volume":"21","author":"Fernandes","year":"2016","journal-title":"Apoptosis"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1089\/thy.2017.0544","article-title":"Comparison of Therapeutic Triiodothyronine Versus Metoprolol in the Treatment of Myocardial Infarction in Rats","volume":"28","author":"Zhang","year":"2018","journal-title":"Thyroid"},{"key":"ref_32","first-page":"864","article-title":"Timedependent and independent effects of thyroid hormone administration following myocardial infarction in rats","volume":"18","author":"Iliopoulou","year":"2018","journal-title":"Mol. Med. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1177\/2048872618770600","article-title":"Thyroid-stimulating hormone and adverse left ventricular remodeling following ST-segment elevation myocardial infarction","volume":"8","author":"Reindl","year":"2019","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s13063-015-0621-5","article-title":"Thyroxine in acute myocardial infarction (ThyrAMI)-levothyroxine in subclinical hypothyroidism post-acute myocardial infarction: Study protocol for a randomised controlled trial","volume":"16","author":"Jabbar","year":"2015","journal-title":"Trials"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/5\/214\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:51:28Z","timestamp":1760363488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/5\/214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,28]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["medicina56050214"],"URL":"https:\/\/doi.org\/10.3390\/medicina56050214","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,28]]}}}