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Achim Peters, MD; Martin Ehlers, MD; Bodo Blank; Dirk Exler; Carol Falk, MD; Thomas Kohlmann, PhD; Bernd Fruehwald-Schultes, MD; Peter Wellhoener, MD; Wolfgang Kerner, MD; Horst L. Fehm, MD

Arch Intern Med. 2000;160:1993-1999.

Background  Abnormalities in cardiac function, eg, arrhythmias and congestive heart failure, often accompany thyrotoxicosis. A relationship between thyroid hormone excess and the cardiac complications of angina pectoris and myocardial infarction (MI) remains largely speculative.

Methods  The results of thyroid function studies on blood samples drawn from a total of 1049 patients (aged 40 years or older) immediately on emergency medical admission were related to frequencies of angina pectoris and myocardial infarction as determined according to current diagnostic algorithms. After 3 years, those patients who had initially presented with angina pectoris or acute MI were observed for subsequent coronary events; of these (n=185), 98% of the subjects (n=181) could be reevaluated.

Results  On hospital admission, the relative rate of angina pectoris and MI was markedly high (odds ratio, 2.6; 95% confidence interval, 1.3-5.2; P=.007) in patients with elevated serum free and total triiodothyronine (T₃) levels. An initially elevated free T₃ level was a risk factor for subsequent coronary events during the 3-year follow-up (adjusted odds ratio, 4.8; 95% confidence interval, 1.3-17.4; P=.02).

Conclusions  An elevation of serum free T₃ levels at hospital admission is associated with a 2.6-fold greater likelihood of the presence of a coronary event. Moreover, an initially elevated T₃ level is associated with a 3-fold higher risk of developing a subsequent coronary event during the next 3 years. Excess T₃ seemed to be a factor associated with the development and progression of acute myocardial ischemia.

From Medical Clinic 1 (Drs Peters, Ehlers, Fruehwald-Schultes, Wellhoener, and Fehm and Messrs Blank and Exler), the Institute for Social Medicine and Epidemiology (Dr Kohlmann), and the Anatomical Institute (Dr Falk), Medical University of Lübeck, Lübeck, Germany; and the Department of Diabetes and Metabolic Disorders, Klinikum Karlsburg, Karlsburg, Germany (Dr Kerner).

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