Dysthyroidism and heart failure: from clinical case to pathophysiology

Abstract

Dysthyroidism affects cardiovascular function in many ways and can cause heart failure. The physiopathological mechanisms underlying the development of heart failure involve both direct intranuclear transcriptional effects of thyroid hormones and specific haemodynamic consequences of vascular modifications induced by dysthyroidism. Phospholamban regulatory action on diastolic ventricular function appears to play a pivotal role in mediating both direct T3 action and adrenal effects on myocardial contractility, possibly explaining the way dysthyroidism mimics sympathoadrenergic alterations on cardiovascular function. Therapeutical approach to cardiovascular disorders in dysthyroidism should focus on both thyroid hormones dysregulation and sympathoadrenergic activity, to attempt a reversal of the associated derangements.