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| ORIGINAL ARTICLE |
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| Year : 2015 | Volume
: 15
| Issue : 2 | Page : 199-203 |
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Correlation of electrocardiographic and lipid profile changes in newly diagnosed hypothyroid subjects
Arpita Ghosh1, Arunima Chaudhuri1, Somenath Ghosh2, Abhijit Kanrar1, Debasis Adhya1, Keya Pal3
1 Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
2 Department of Community Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
3 Department of Biochemistry, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| Date of Web Publication | 6-May-2015 |
Correspondence Address:
Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-6308.156375
Background: Thyroid dysfunction has a great impact on lipid profile and other cardiovascular risk factors. Aims: This study was conducted to assess the association between electrocardiography (ECG) changes and lipid profile in newly diagnosed hypothyroid patients in a rural population of eastern India. Materials and Methods: This cross-sectional pilot project was conducted in a tertiary care hospital in a time span of 1-year on hundred newly diagnosed hypothyroid patients. Fasting blood samples were drawn for assessment of lipid profile followed by Anthropometric measurements. Basal heart rate and blood pressure were recorded, followed by ECG. Results: A total of 85 subjects were female and rest 15 were male. Eleven (73.33%) male hypothyroid patient and 41 (48.24%) female hypothyroid patient had thyroid-stimulating hormone (TSH) level >10. Four (26.67%) male hypothyroid patients and 44 (51.76%) female hypothyroid patients had TSH level ≤10. Fifty-seven hypothyroid patients showed cholesterol level ≤200. Eight (53.33%) male hypothyroid patients and 43 (50.89%) female hypothyroid patient had triglyceride level ≤150 mg/dl. Among 100 hypothyroid patients, 13 (15.29%) female hypothyroid patient had sinus bradycardia and 9 (10.59%) had poor progression of R wave. Two (13.33%) male hypothyroid patient and 19 (22.35%) female hypothyroid patients showed low voltage ECG. QRS complex of ECG showed statistically significant relationship (P < 0.000) with TSH level. All parameters of lipid profile except high-density lipoprotein had a significant negative co-relation with QRS complex. Conclusions: The present study shows that there are exit significant changes in ECG with increased TSH levels and dyslipidemia. Early diagnosis of these changes may help in proper management of these patients. أظهروا تقدما )% ومن بينصيخشت مت نيذلا ةيقردلا ةدغلا للاتعأ ىضرم يف نوهدلا لدعم و يئابرهكلا بلقلا طيطخت ةقلاعاثيدح هتلااح
نم كلذ ريغ و مدلا يف نوهدلا ىوتسم يف ريبك ريثأث ةيقردلا ةدغلا فئاظو للاتخلا :ةساردلا ةيفلخ.بلقلا ةيعوأ ىلع رطاخملا
ىوتسمو يئابرهكلا بلقلا طيطخت تاريغت نيب ةقلاعلا مييقتل ةسارّدلا هذه تيرجأ :ةساردلا فادهأ ناكس نم ددع يف اثيدح مهتلااح صيخشت مت نيذلا ةيقردلا ةدغلا للاتعا ىضرم يف مدلا يف نوهدلا.دنهلا يقرش ةيفير ةقطنم
ةئام ىلع دحاو ماع ةدمل ةيثلاثلا ةياعرلا ىفشتسم يف ةساردلا هذه تيرجأ :اهدارفأ و ةساردلا جهنم يف للاتعاب نوباصم اثيدح مصيخشت مت نيذلا )روكذلا نم 15 و ثانلإا نم 85 ( ىضرملا نم كلذ تلت ،مدلا يف نوهدلا ىوتسم مييقتل نيمئاصلا ىضرملا نم مدلا تانيع بحس مت . ةيقردلا ةدغلا بلقلا طيطخت و .مدلا طغض لدعم و بلقلا تابرض لدعم ليجست مت و .ةيرتموبرثنلإا تاسايقلا ضعي ) ECG( يئابرهكلا
ثانلإا نم 14و )%73.33( روكذلا ىضرملا نم رشع دحأ نأ ةساردلا جئاتن ترهظأ :جئاتنلا روكذلا نم ةعبرأ دنعو مهدنع>10 )TSH( ةيقردلا ةدغلازيفحت نومره ىوتسم ناك ) %48,24( لورتسلكلا ىوتسم ناك ىضرملا نم 57 دنعو <10 )%76,,51( ثانلإا نم 44و )%26.67( ( ثانلإا نم 43 و )%53.33(روكذلا نم 8 دنع ةيثلاثلانوهدلا ىوتسم و _<200 مهدنع 100 مريض ظهر لدى 13 من الإناث ) 15.29 %( بطء القلب الجيبي و 9 مرضى ) 10.59 <mg\dl150(%50,89
وأظهر اثنان من المرضى الذكور ) 13.335 ( و 19 من الإناث ) 22.35 %( انخفاضا في تخطيط القلب الهكربائي. وأظهر )R( بطيئا في موجة
كما أظهرت قياسات مستوى الدهون )باستثناء .P=0. تخطيط القلب الكهربائي علاقة ذات دلالة إحصائية مع مستوى هرمون الغدة الدرقية: 000
البروتين الدهني عالى الكثافة( علاقة ذات دلالة إحصائية سلبية مع تخطيط القلب الكهربائي.
الاستنتاجات: أظهرت هذه الدراسة تغيرات كبيرة في تخظيظ القلب الكهربائي مع زيادة مستويات هرمون الغدة الدرقية وزيادة مستوى الدهون
في الدم. كما أظهرت الدراسة أن التشخيص المبكر لهذة التغيرات قد يساعد في العلاج المناسب للمرضى.
Keywords: Dyslipidemia, electrocardiography changes, hypothyroidism
How to cite this article:
Ghosh A, Chaudhuri A, Ghosh S, Kanrar A, Adhya D, Pal K. Correlation of electrocardiographic and lipid profile changes in newly diagnosed hypothyroid subjects. Saudi J Sports Med 2015;15:199-203 |
How to cite this URL:
Ghosh A, Chaudhuri A, Ghosh S, Kanrar A, Adhya D, Pal K. Correlation of electrocardiographic and lipid profile changes in newly diagnosed hypothyroid subjects. Saudi J Sports Med [serial online] 2015 [cited 2023 Jun 10];15:199-203. Available from: https://www.sjosm.org/text.asp?2015/15/2/199/156375 |
| Introduction | |  |
Hypothyroidism refers to insufficient production of thyroid hormones and can occur as primary, secondary or tertiary endocrine disease. In primary hypothyroidism, T3 and T4 levels are abnormally low, and thyroid-stimulating hormone (TSH) is high. In secondary and tertiary hypothyroidism, both thyroid hormones and TSH are low. [1],[2],[3],[4],[5]
T3 and T4 are secreted from the thyroid gland. Much of T3 is also made by peripheral conversion of T4 to T3, primarily through a nuclear receptor that regulates gene expression. T3 has broad effects on metabolism and cardiovascular function in adult. [2],[3],[4],[5],[6]
Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Overall, thyroid dysfunction should be taken into account when evaluating and treating dyslipidemic patients. Hypothyroidism is associated with elevated plasma low-density lipoprotein cholesterol (LDL-C) levels due primarily to a reduction in hepatic LDL receptor function and delayed clearance of LDL. Hypothyroid patients also frequently have increased levels of circulating intermediate-density lipoprotein (IDL), and some patients with hypothyroidism also have mild hypertriglyceridemia. Because hypothyroidism is often subtle and therefore easily overlooked, all patients presenting with elevated plasma levels of LDL-C, IDL or triglycerides should be screened for hypothyroidism. [3],[4],[5],[6],[7],[8],[9],[10]
The electrocardiography (ECG) of hypothyroidism classically demonstrate sinus bradycardia with low voltage complex and ST and T wave abnormality. Besides that, hypothyroidism may be associated with atrioventricular and intraventricular conduction disturbances. Extrasystoles and tachyarrhythmias of both atrial and ventricular origins have been described in hypothyroidism with the ventricular tachyarrhythmias associated with prolonged QT interval. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10]
Literature search could reveal that there was significant cardiovascular morbidity in hypothyroid patients. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10] The present study was conducted to assess the association between ECG changes and lipid profile in newly diagnosed hypothyroid patients in a rural population of eastern India, so that early measures may be implemented to decrease morbidity and mortality.
| Materials and methods | | |
This cross-sectional pilot project was conducted in a tertiary care hospital of Eastern India in a time span of 1-year on hundred newly diagnosed hypothyroid patients attending medicine outpatient department. Institutional ethical clearance and informed consent of the subjects were taken before commencement of the study. Hypothyroid patients were selected in 1-day/week. By systematic random sampling technique two newly diagnosed hypothyroid patients were chosen out of 9-10 newly diagnosed hypothyroid patients in every day. Hence, 50 weeks were involved in data collection and 50 × 2 = 100 patients were selected as study subjects.
Inclusion criteria
Newly diagnosed hypothyroid patient aged more than 18 years attending Burdwan Medical College and Hospital.
Exclusion criteria
Patients on antiarrythmic drugs, hypolipidemic drugs, antihypertensives, steroids, subjects suffering from cardiac disease-congenital heart disease, rheumatic heart disease, ischemic heart disease, renal disease, liver disease, cardiovascular diseases, diabetes mellitus, and critically ill-patients admitted in intensive care unit were excluded.
On first appointment, particulars of the subject, chief complaints, personal history, family history, history of past illness and treatment history of the subjects were carefully recorded. General physical examinations were done, and informed consent was taken. Pretest instructions were given to avoid consumption of any drugs that may alter the autonomic function 48 h prior to the test. The subjects were advised for a good restful sleep. On the day of the test, no cigarette, nicotine, coffee, or drugs were permitted. Fasting blood samples were drawn for assessment of lipid profile, followed by Anthropometric measurements. Basal heart rate and blood pressure were recorded, followed by ECG recording.
Anthropometry
Body weight
A digital weighing scale was used to measure body weight with an accuracy of ±100 g. Subjects were weighed without their shoes.
Height
Standing body height was measured without shoes to the nearest 0.5 cm with the use of height stand with shoulders in relaxed position and arms hanging freely.
Body mass index
The index was computed as weight in kg/height in meter.
Biochemical analyses
Lipid profile
Early morning venous samples were collected in plain bulbs from the subjects for analysis of lipid profile following a 12 h overnight fasting. Samples were collected, centrifuged and analyzed on the same day.
Thyroid profile
Early morning venous samples were collected in plain bulbs from the subjects for analysis of T4 and TSH overnight fasting. [9],[10],[11],[12],[13] Samples were collected, centrifuged and analyzed on the same day.
T4 analysis
Serum total T4 was measured by immunoassay. This assay based upon the competitive method. Microwells are precoated with anti-T4. The enzyme conjugate is formed by labeling T4 with horseradish peroxides. This complex catalyzes the substrates, resulting in a chromogenic reaction. The color intensity is inversely proportional to the amount of T4.
Thyroid-stimulating hormone analysis
Thyroid-stimulating hormone was measured by chemiluminescent assay. This assay is based upon the sandwich method. Microwells are precoated with anti-TSH. The enzyme conjugate is formed by labeling TSH with horseradish peroxides. Then a complex is generated between the solid phase, the TSH within the sample and enzyme-linked antibody by immunological reaction. This complex catalyzes the substrates, resulting in a chromogenic reaction. The color intensity is inversely pro-portional to the amount of TSH.
Subjects were divided into two groups according to TSH levels (patients having TSH level >10 patients had TSH level ≤10). Forty eight patients had TSH level >10 and 52 had TSH level ≤ 10.
The computer software "Statistical Package for the Social Sciences (SPSS)," version 16 (SPSS Inc., Released 2007, SPSS for Windows, Version 16.0, Chicago, IL, USA) was used to analyze data of the above two groups of patients. P < 0.05* was considered significant and < 0.01** as highly significant.
| Results | | |
Eighty-five subjects were female and rest 15 were male. Thirteen female study subjects had pulse rate <60 beats/min. Eleven (73.33%) male hypothyroid patient and 41 (48.24%) female hypothyroid patient had TSH level >10. Four (26.67%) male hypothyroid patients and 44 (51.76%) female hypothyroid patients had TSH level ≤10. Fifty seven hypothyroid patients showed cholesterol level ≤200. Among them 13 (86.67%) were male hypothyroid patients and 44 (51.76%) were female hypothyroid patients. Rest hypothyroid patient had cholesterol level >200. Eight (53.33%) male hypothyroid patients and 43 (50.89%) female hypothyroid patient had triglyceride level ≤150 mg/dl. Rest hypothyroid patient had triglyceride level >150 mg/dl. Thirteen (86.67%) male hypothyroid patients and 20 (29.53%) female hypothyroid patient had LDL level ≤100 mg/dl. Rest hypothyroid patient had LDL level >100 mg/dl. Cholesterol, triglyceride, LDL, very LDL (VLDL) level of study subjects was more in the hypothyroid patient having TSH level >10 comparisons to hypothyroid patient having TSH level ≤10 [Table 1]. Only high-density lipoprotein (HDL) level of study subjects was less in the hypothyroid patient having TSH level >10 comparison to other group. P-R interval, QRS complex, Q-T interval were 0.062 ± 0.021, 0.899 ± 359, 0.35 ± 0.038 respectively. | Table 1: Comparison lipid profile according to the TSH level in hypothyroid patient
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Among 100 hypothyroid patients, 13 (15.29%) female hypothyroid patient had sinus bradycardia and 9 (10.59%) had poor progression of R wave. Two (13.33%) male hypothyroid patient and 19 (22.35%) female hypothyroid patients showed low voltage ECG. ECG of 14 (16.47%) female hypothyroid patients showed nonspecific ST changes. Rest 43 hypothyroid patients had normal ECG. QRS complex of ECG showed statistically significant relationship (P < 0.000) with TSH level [Table 2]. Lipid Profile parameters excepting HDL had a significant negative co-relation with QRS complex [Table 3]. | Table 2: Comparison of ECG finding according to the TSH level in hypothyroid patient
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 | Table 3: Correlation of QRS complex of ECG, lipid profile and thyroid function tests
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| discussion | | |
The present cross-sectional, observational study was carried on newly diagnosed hypothyroid patients during 2013-2014. Mean age of study subject was 36 years with a female predominance (85%). In studies by Shah et al., [5] the mean age of study subject was 35 years with a female predominance 73.33%. Thirty percent patient showed normal ECG and bradycardia was the most common finding seen in 40% patients. Low voltage complexes were seen in 33% patients. In the present study, 13 (15.29%) female hypothyroid patient had sinus bradycardia and 9 (10.59%) had poor progression of R wave. Two (13.33%) male hypothyroid patient and 19 (22.35%) female hypothyroid patients showed low voltage ECG. ECG of 14 (16.47%) female hypothyroid patients showed nonspecific ST changes. Rest 43 hypothyroid patients had normal ECG.
Satpathy et al. [6] studied 72 thyroid dysfunction patients. 44 (61.11%) were suffering from hypothyroidism with a peak incidence of thyroid dysfunction in 3 rd and 4 th decade. Maximum number of hypothyroid patients (73%) had either borderline high (36.6%) or high (36.36%) serum cholesterol. Horizontal ST Segment depression was the most common ECG finding in 15 hypothyroids (34%). Ten (23%) hypothyroids had sinus bradycardia in ECG, being the second most common ECG abnormality. In present, study, there was 100 hypothyroidism with similarly peak incidence of thyroid dysfunction in 3 rd and 4 th decade. Lipid profile analysis showed increase of cholesterol, triglyceride, LDL, VLDL level, which had statistically significant relationship with increased TSH level (P = 0.000, P = 0.000, P = 0.000, P = 0.000 respectively) and there were also statistically significant relationships of decreased HDL level (P = 0.000) with increased TSH level. Two (13.33%) male hypothyroid patient and 19 (22.35%) female hypothyroid patients showed low voltage ECG which was the commonest ECG change of the present study.
In studies by Alzaidy [7] 79.1% of the patients were having mild elevation in TSH level (6.1-9.2 mIU/L), and 20.9% of them were having marked TSH elevation (10.4-12.8 mIU/L). Lipid profile for all patients of the study showed elevation in the levels of total cholesterol and triglycerides over the normal ranges, and normal level of HDL. However, in the present study there were elevation in the levels of total cholesterol and triglycerides over the normal ranges in respect of the increase of TSH level and decrease HDL level with increase TSH level.
In studies by Sureshbabu et al. [12] ECG was abnormal in 31% cases, ECHO was abnormal in 23%, dyslipidemia was present in 41% and pericardial effusion in 4%. In the present study, 57% hypothyroid patients had abnormal ECG. The present study also showed that cholesterol, triglyceride, LDL, VLDL level had statistically significant relationship with increased TSH level (P = 0.000, P = 0.000, P = 0.000, P = 0.000, respectively) and there were also statistically significant relationships of decreased HDL level (P = 0.000) with increased TSH level.
Galetta et al. [3] observed that in hypothyroid patients, standard deviation of all R-R intervals was inversely related (by simple regression) to serum TSH levels, P < 0.01**), while QT dispersion (P < 0.01**) was directly related to TSH. The present study showed that only QRS complex of ECG had statistically significant (P = 0.000) relationship with TSH level. Studies by Cho et al. [14] also showed that hypothyroidism was associated with ECG changes. In studies by Agarwal et al., [15] one patient had an episode of ventricular tachycardia associated with long QT interval. Three patients (15%) had low voltage QRS complexes and one (10%) patient had nonspecific T wave changes.
Studies by Tunbridge et al. [16] showed that there was a weak association between minor ECG changes and minor degrees of hypothyroidism (but not thyroid antibodies) in females which was independent of other variables. The significance of this observation depended upon the interpretation of the ECG abnormalities and would only be established by longitudinal studies. No association was noted between lipid concentrations and thyroid antibodies or minor degrees of hypothyroidism.
| Conclusions | | |
The present study shows that there are exit significant changes in ECG with increased TSH levels and dyslipidemia. Early diagnosis of these changes may help in proper management of these patients.
| References | | |
| 1. | Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J 2011;5:76-84.  |
| 2. | Shekhar R, Srinivas CH, Das MC. Lipid profile in 'Newly Diagnosed' an 'On Treatment' hypothyroid. J Clin Diagn Res 2011;5:998-1000. |
| 3. | Galetta F, Franzoni F, Fallahi P, Tocchini L, Braccini L, Santoro G, et al. Changes in heart rate variability and QT dispersion in patients with overt hypothyroidism. Eur J Endocrinol 2008;158:85-90. |
| 4. | Razvi S, Weaver JU, Vanderpump MP, Pearce SH. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: Reanalysis of the Whickham Survey Cohort. J Clin Endocrinol Metab 2010;10:1749. |
| 5. | Shah SK, Kilari M, Shah NK. Cross sectional study of cardiovascular manifestations of hypothyroidism. J Eval Med Dent Sci 2013;2:5021-9. |
| 6. | Satpathy PK, Diggikar PM, Sachdeva V, Laddha M, Agarwal A, Singh H. Lipid profile and electrocardiographic changes in thyroid dysfunction. Med J DY Patil Univ 2013;6:250-3.  |
| 7. | Alzaidy MS. Cardiovascular manifestations of hypothyroidism. Med J Babylon 2011;8:592-601. |
| 8. | Shilpashree MK, Ravi BV. Serum lipoprotein (a) and lipid profile in hypothyroidism. J Clin Biomed Sci 2014;4:235-9. |
| 9. | Prakash A, Lal AK. Serum lipids in hypothyroidism: Our experience. Indian J Clin Biochem 2006;21:153-5. |
| 10. | Singh K, Singh S. Alterations in lipid fraction levels in subclinical hypothyroidism in North Indian population. Indian J Fundam Appl Life Sci 2011;1:127-32. |
| 11. | Sunanda V, Sangeeta S, Rao BP. Study of lipid profile in hypothyroidism. Int J Biol Med Res 2012;31373-6. |
| 12. | Sureshbabu KPG, Oswal A. Cardiac manifestations in hypothyroidism - A cross sectional study. Res J Pharm Biol ChemSci 2014;5:966-75. |
| 13. | Neves C, Alves M, Medina JL, Delgado JL. Thyroid diseases, dyslipidemia and cardiovascular pathology. Rev Port Cardiol 2008;27:1211-36. |
| 14. | Cho SG, Song HC, Oh JR, Chong A, Kang SR, Kim J, et al. The electrocardiographic changes mimicking ischemic heart diseases in patients in hypothyroid state for preparation of I-131 therapy. J Nucl Med 2012;53:2081. |
| 15. | Agarwal SC, Hira HS, Sibal L. Electrocardiographic changes in patients with hypothyroidism. Br Endocr Soc Joint Meet 2004;7:246. |
| 16. | Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. Lipid profiles and cardiovascular disease in the Whickham area with particular reference to thyroid failure. Clin Endocrinol (Oxf) 1977;7:495-508. [ PUBMED] |
[Table 1], [Table 2], [Table 3]
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