RESUMO
The low T3 syndrome, the most common type of Sick Euthyroid syndrome, once believed to be a beneficial adaptive mechanism under conditions of stress, has emerged as a strong prognostic determinant in chronic systolic heart failure. Sick Euthyroid Syndrome is frequently observed in Chronic Heart Failure, Acute Myocardial Infarction. Acute myocardial infarction (AMI) may be associated with a number of endocrine alterations, including those of the SES which reflect the acute hormone response to stress and trauma. It is known from several studies that several cytokines can be found elevated in patients with cardiac ischemia or AMI. From in vitro studies it is of particular interest that ischemic myocytes produce cytokines such as interleukin-6 (IL-6) and its synthesis is accelerated by reperfusion. Interleukin-6 seemed to be an important cytokine produced by the injured myocytes in patients with AMI, and strong negative correlation between serum IL-6 concentration and left ventricular ejection fraction (LVEF) has been demonstrated. Similar observations have been made by studying tumor necrosis factor-a (TNF-a), IL-1a and soluble IL-2 receptor (sIL-2-R) which were found to be significantly elevated in AMI, with the highest levels noted in the most severe and complicated cases of myocardial infarction. MATERIAL: Study design : hospital based analytical cross-sectional study. MATERIALS: serial ECGs, Thyroid profile (FT3, FT4, TSH, rT3) and echocardiography. The study group included 100 patients who were admitted in ward/ICU with the diagnosis of myocardial infarction. INCLUSION CRITERIA: All patient with age 18yrs or above. History of chest pain with ECG changes and cardiac biomarkers of myocardial infarction. EXCLUSION CRITERIA: Patient below 18 yrs. Known case of hypothyroidism/hyperthyroidism Known case of malignancy Patients who have reached iodinated contrast in past one week. OBSERVATION: Out of 100 patients included with myocardial infarction, 27 patients had sick euthyroid state. Seven patients died, five with SES and two with normal thyroid profile. Mean value of fT3 was 2.37pg/ml for the patients who improved and 1.61pg/ml for the patient who expired, indicating statistical significance. Mean fT4 and TSH was not significant across those who improved or expired. However high rT3 value was associated with the worst outcome. CONCLUSION: Prevalence of SES is commom in patient with ACS. SES is a strong prognostic indicationin ACS. It is frequently observed in chronic heart failure, acte MI and is related to increased mortality.
