ETA2023 45th Annual Meeting of the European Thyroid Association ETA 2023 Oral Session 4: Young Investigators / Clinical and Translational (6 abstracts)
Cardiac function during early treatment for differentiated thyroid carcinoma
Mirthe Links 1 , Joop Lefrandt 2 , Trynke Van Der Boom 3 , Tineke Willems 4 , Peter van der Meer 5 , Thera Links 6 & Wouter Zandee 7
1University Medical Center Groningen, University of Groningen, Department of Endocrinology, Groningen, Netherlands; 2University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Division of Vascular Medicine, Groningen, Netherlands; 3University Medical Center Groningen, Department of Endocrinology, Hpc Aa31, Department of Internal Medicine, Division of Endocrinology & Vascular Medicine, Groningen, Netherlands; 4University Medical Center Groningen, Department of Radiology, Groningen, Netherlands; 5University Medical Center Groningen, Amsterdam, Netherlands; 6University Medical Center Groningen, Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Department of Endocrinology, Groningen, Netherlands; 7University Medical Center Groningen, Groningen University, Groningen, Netherlands
Background: Differentiated thyroid carcinoma (DTC) survivors have an increased risk of cardiovascular mortality but, the pathophysiological mechanism remains largely unknown. Early treatment for high-risk DTC entails thyroid surgery, radioiodine therapy with thyroid hormone (TH)-withdrawal, and thyroxine suppression therapy (THST). During treatment, patients cycle from severe hypothyroidism to exogenous subclinical hyperthyroidism. TH changes in early DTC treatment might affect cardiac workload and cause structural cardiac changes. Cardiac Magnetic Resonance imaging (CMR) enables accurate imaging of ventricular volumes and is considered the gold standard to investigate cardiac structure and systolic function.
Aim: To investigate cardiac function and morphology during changes in TH-levels in early DTC treatment by means of CMR.
Methods: In 18 patients with DTC (female: 89%; median age 47 [IQR 35-59] years), CMR was performed in 2 consecutive study visits, during short-term hypothyroidism and after 20 weeks of THST (TSH targeted <0.1 mU/l). In 5 patients an extra CMR was performed before treatment, during euthyroidism. The paired t-tests or Wilcoxon Singed Rank test were performed as appropriate. CMR data was indexed for body surface area (m2) and data is presented as median [interquartile range].
Results: During THST, cardiac function was increased compared to values during TH-withdrawal (Table 1). In patients included during euthyroidism heart rate, left and right ventricular ejection fraction, stroke volume-index and cardiac-index decreased during TH-withdrawal, but were not completely restored during THST to euthyroid values in 3 out of 5 patients.
| TH-withdrawal | THST | P | ||||
| Heart rate | (bpm) | 61.5 | (57.5-64.3) | 72.5 | (63.8-79.8) | 0.01 |
| Left ventricle | ||||||
| ED Volume-index | (mL/m2) | 64.1 | (50.0-68.2) | 69.7 | (66.4-73.6) | <0.01 |
| ES Volume-index | (mL/m2) | 26.1 | (23.4-30.3) | 25.2 | (21.6-30.4) | 0.96 |
| Stroke volume-index | (mL/m2) | 35.5 | (27.0-41.9) | 43.7 | (38.6-48.5) | <0.01 |
| Ejection fraction | (%) | 55.9 | (49.7-61.4) | 63.6 | (59.0-66.6) | 0.03 |
| Cardiac-index | L/(m2•min) | 1.9 | (1.6-2.5) | 3.1 | (2.8-3.4) | <0.01 |
| Right ventricle | ||||||
| ED Volume-index | (mL/m2) | 69.6 | (58.3-75.0) | 70.4 | (65.4-80.4) | 0.06 |
| ES Volume-index | (mL/m2) | 38.8 | (33.9-42.8) | 38.6 | (34.0-45.6) | 0.67 |
| Stroke volume-index | (mL/m2) | 32.6 | (26.3-36.0) | 31.4 | (27.8-40.5) | 0.41 |
| Ejection fraction | (%) | 46.7 | (43.5-50.8) | 44.2 | (41.6-50.2) | 0.73 |
| Cardiac-index | L/(m2•min) | 1.8 | (1.4-2.2) | 2.4 | (1.9-2.9) | 0.04 |
| Abbreviations: ES=End Systolic, ED=End Diastolic. | ||||||
Conclusion: These results suggest that cardiac work, particularly in the left ventricle, is associated with changes in TH-levels during early DTC treatment. This is most importantly demonstrated by increases in left ventricular ejection fraction, stroke volume index and cardiac index during THST. However, results from the small subgroup analysed during euthyroidism possibly suggest that cardiac function does not recover in all patients during THST.
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