Thyroxine increases Serca2 and Ryr2 gene expression in heart failure rats with euthyroid sick syndrome

ABSTRACT Objective The current study was aimed at analyzing sarcoplasmic reticulum Ca2+ ATPase (Serca2) and ryanodine receptor type 2 (Ryr2) gene expression in rats subjected to surgery that induced HF and were subsequently treated with T4 using physiological doses. Materials and methods HF was induced in 18 male Wistar rats by clipping the ascending thoracic aorta to generate aortic stenosis (HFS group), while the control group (9-sham) underwent thoracotomy. After 21 weeks, the HFS group was subdivided into two subgroups. One group (9 Wistar rats) with HF received 1.0 µg of T4/100 g of body weight for five consecutive days (HFS/T4); the other group (9 Wistar rats) received isotonic saline solution (HFS/S). The animals were sacrificed after this treatment and examined for signs of HF. Samples from the left ventricles of these animals were analyzed by RT-qPCR for the expression of Serca2 and Ryr2 genes. Results Rats with HF developed euthyroid sick syndrome (ESS) and treatment with T4 restored the T3 values to the Sham level and increased Serca2 and Ryr2 gene expression, thereby demonstrating a possible benefit of T4 treatment for heart function in ESS associated with HF. Conclusion The T4 treatment can potentially normalize the levels of T3 as well elevated Serca2 and Ryr2 gene expression in the myocardium in heart failure rats with euthyroid sick syndrome.

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

ABSTRACT Objective To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34.

Algunas variables de interés para un equipo multidisciplinario regional en el nódulo eutiroideo asociado a la gestación / Euthyroid nodule associated with pregnancy, some interesting variables for a regional multidisciplinary team

El 4 por ciento de la población tiene un nódulo tiroideo, con mayor prevalencia en mujeres fértiles, se reconoce la gestación como factor acelerador de malignidad. Se realizó un estudio longitudinal prospectivo para distinguir aspectos diagnóstico-epidemiológicos relacionados con la evolución final del nódulo eutiroideo asociado a la gestación, en una consulta clínico/obstétrica regional en el oeste de la Habana desde enero 2004-octubre 2009; se definió: edad según número de embarazos previos, tamaño ultrasonográfico del nódulo atendiendo al tiempo gestacional, complicaciones materno/fetales y grupo étnico, más diagnóstico anatomopatológico final. Se muestrearon por conveniencia 90 gestantes empleando criterios clínicos/ultrasonográficos de nódulo tiroideo normofuncionante. Predominaron las pacientes entre 25-29 años y 72,5 por ciento tuvo 2 o más gestaciones previas, con pocos hijos, y coeficiente de correlación significativo para la edad según número de gestaciones previas. Presentaron al 2do semestre medidas ecográficas nodulares mayores de 2 cm, 33 gestantes, aumentando de tamaño según tiempo gestacional por coeficiente de correlación intraclase calculado. Hipertensión gestacional llevó significación entre las complicaciones, presentaron mayor número las gestantes de etnia negra. No fue concluyente 27,5 por ciento de las BAAF, con sensibilidad diagnóstica del 72,5 por ciento. Aunque al final de la gestación la enfermedad nodular del tiroides curse sin complicaciones materno/fetales, estas pacientes son jóvenes, sin buen control de la fecundidad lo que pudiera aumentar el riesgo de malignidad tiroidea indistintamente de los medios empleados para su diagnóstico, constituyen el estado funcional glandular una importante variable independiente de riesgo

The 4,96 percent of the population presenting with a thyroid nodule with a great prevalence in fertile women, recognizing the pregnancy as a malignancy accelerator factor. A prospective and longitudinal study was conducted to characterize diagnostic-epidemiological features related to final course of euthyroid nodule associated with pregnancy in patients seen in a regional clinical-obstetrical consultation of the Havana's west from January, 2004 to October, 2009, identifying age according to number of previous pregnancies, nodule size by US y pregnancy time, mother/fetal complications and ethnic group and more anatomical-pathological diagnoses. By convenience 90 pregnants were sampled using clinical and ulrasonography criteria of the thyroid normofunctional nodule. There were predominance of patients aged between 25-29 and the 72.5 percent had two or more previous pregnancies with a few children and a significant correlation coefficient for age according to previous pregnants. At the second trimester they had nodular echography measures more than 2 cm (33 pregnants) increasing the size according to the gestational time y estimated intra-class correlation coefficient . Gestational high blood pressure was significant among the complications, with more black pregnants. The 27,5 percent of fine needle aspiration biopsy (FNAB) was not conclusive with a diagnostic sensitivity of 72,5 percent. Although at the end of pregnancy the nodular thyroid disease has not mother/fetal complications, these patients are young without a good control of fertility leading to an increase of thyroid malignancy risk, unlike the methods used for its diagnosis, the glandular functional status is a significant independent risk variable

Perfil dos hormônios tireoidianos nas síndromes coronarianas agudas / Thyroid hormone profile in acute coronary syndromes

OBJETIVO: Descrever o perfil hormonal tireoidiano em pacientes com síndromes coronarianas agudas (SCA), e nos grupos: 1) angina instável e/ou infarto agudo do miocárdio sem supradesnivelamento de segmento ST (AI/IAM sem supra ST); 2) infarto agudo do miocárdio com supradesnivelamento do segmento (IAM com supra ST), e nos pacientes que evoluíram ou não a óbito conforme os grupos. MÉTODOS: Foram estudados prospectivamente setenta pacientes portadores de SCA, internados na unidade coronariana do Hospital dos Servidores do Estado/RJ. As amostras sangüíneas foram coletadas nos primeiro, quarto e sétimo dias de internação. Exame clínico e eletrocardiograma foram realizados no período de internação. RESULTADOS: Dos 70 pacientes admitidos, 13 (18,6 por cento) apresentaram a "síndrome do eutireoidiano doente" (SED), que consiste na queda do hormônio T3 e ou T3 livre, aumento do hormônio T3 reverso (rT3) e inalteração dos hormônios TSH, T4 e T4 livre. Nos pacientes do grupo IAM com supra ST, observaram-se elevação precoce e maiores médias do hormônio tireoidiano T3 reverso (rT3) e menores médias dos hormônios T3 e T3 livre. Nos coronariopatas que evoluíram a óbito, observamos achados hormonais condizentes com os encontrado na SED, com valores médios expressivos dos hormônios rT3 e T3. CONCLUSÃO: Os resultados apresentados neste estudo mostram a importância do reconhecimento da "síndrome do eutireoidiano doente" nos pacientes coronariopatas, sugerindo associação com pior prognóstico nos pacientes com síndrome coronariana aguda.

OBJECTIVE: To describe thyroid hormone profile in patients with acute coronary syndromes (ACS), divided into two groups: 1) unstable angina and/or non-ST-segment elevation acute myocardial infarction (UA/NSTEMI); 2) ST-segment elevation acute myocardial infarction (STEMI), as well as in patients that progressed or not to death, according to the groups. METHODS: Seventy ACS patients admitted to the coronary care unit of the Hospital dos Servidores do Estado, Rio de Janeiro, were prospectively studied. Blood samples were collected on day 1 and on days 4 and 7 following admission. Clinical evaluation and electrocardiograms were performed during hospitalization. RESULTS: Of the 70 patients admitted, 13 (18.6 percent) had "euthyroid sick syndrome" (ESS), a condition characterized by decreased serum T3 and/or free T3, increased serum reverse T3 (rT3), plus normal serum TSH, T4, and free T4. Patients belonging to the STEMI group showed early elevations, in addition to higher mean reverse T3 (rT3) and lower mean T3 and free T3 levels. In coronary heart disease patients that progressed to death, hormonal findings were consistent with those found in the ESS, with more expressive rT3 and T3 mean values. CONCLUSION: Our results show the importance of recognizing the "euthyroid sick syndrome" in coronary heart disease patients, suggesting an association with poorer prognosis in patients with acute coronary syndrome.

Hipertiroxinemia con eutiroidismo clínico: análisis a propósito de un caso / Hyperthyroxinemia and clinical euthyroidism: report of one case

The association of hyperthyroxinemia and euthyroidism is frequent and characterized by high plasma thyroxin concentrations, normal TSH values and absence of clinical signs of hyperthyroidism. We report an asymptomatic 28 years old male presenting with a serum total plasma thyroxin of 18.5 µg/dl (N 6.1-12.5), a free thyroxin of 2.9 ng/dl (N 0.8-1.4), a TSH of 3.4 µIU/ml (N 0.5-5), and a triiodothyronine of 128 ng/dl (N 80-180). Laboratory assessment did not find high thyroxin binding globulin, albumin or prealbumin concentrations or antithyroxin antibodies. The thyroxin binding capacity of albumin was elevated to 58.2 µg/dl (N 11.5-34.1). TSH responded normally to TRH stimulus and was suppressed with exogenous triiodothyronine, which caused an hyperthyroid syndrome. We concluded that this patient had a familial dysalbuminemia