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Euthyroid Sick Syndrome in Acute Ischemic Syndromes

Second Department of Cardiology, St Andreas Patras State Hospital

P.A. Kliridis

Second Department of Cardiology, St Andreas Patras State Hospital

A.A. Panagiotopoulos

Second Department of Cardiology, St Andreas Patras State Hospital

C.P. Goritsas

Department of Internal Medicine, University of Patras Medical School

P.J. Vassilakos

Department of Nuclear Medicine, University of Patras Medical School, Patras, Greece

The purposes of this study were to assess the occurrence of euthyroid sick syndrome in patients with acute myocardial infarction (AMI) or unstable angina (UA), and the relationship with β-blocker or thrombolytic therapy. Plasma triiodothyronine (T3), reverse T3 (rT₃), free T₃ (FT₃), thyroxine (T₄), free T₄ (FT4), thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG), and albumin (ALB) levels were determined in 95 patients (59 males, 36 females, aged 58.4 ±9) with AMI and 19 patients (13 males, 6 females aged 54.7 ± 12.3) with UA for 5 consecutive days from the onset of the acute syndrome and 1 month later. Patients were divided according to β-blocker therapy and thrombolytic therapy. There was a significant T₃ decrease and rT₃ increase in all patients during the first 5 days following admission (p < 0.05). FT₃ and FT4 remained unchanged during the study. In patients with complicated infarctions, the rT₃ increase and the T₃ decrease were significantly greater compared to those with uncom plicated infarctions (p < 0.03). TSH, T₄, TBG, and ALB were significantly (p<0.05) decreased only in complicated infarctions. No differences were observed between patients with or without thrombolysis or patients with or without β-blocker treatment. The apparent decrease in T₃, the increase in rT₃ levels and the decreased TSH and T₄ levels, show clearly that the euthyroid sick syndrome (low T3) occurs not only in AMI but also in UA. In addition, these hormonal changes are not affected by β-blocker therapy and thrombolysis does not influence the occurrence of the syndrome. The degree of T₃ decrease is proportional to the severity of cardiac damage and may have a possible prognostic value.

Angiology, Vol. 53, No. 6, 699-707 (2002)
DOI: 10.1177/000331970205300611


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