A STUDY ON EFFECT OF PRIMARY HYPOTHYROIDISM ON CARDIAC DIASTOLIC FUNCTION

AKHTER M.¹, REHMAN A.², KADLA S.A.³, SAJAD H.⁴, HAMID S.⁵, KAWOOSA Z.⁶, RASHID A.F.^7
1Department of Medicine, Govt. Medical College, Srinagar- 190 010, J&K, India.
²SKIMS Medical College, Srinagar-190 010, J&K, India.
³Department of Medicine, Govt. Medical College, Srinagar- 190 010, J&K, India.
⁴Department of Anatomy, SKIMS Medical College, Bemina- 190 018, J&K, India.
⁵SKIMS, Soura, Srinagar-190 010, J&K, India.
⁶Department of Medicine, SKIMS Medical College, Srinagar- 190 010, J&K, India.
⁷SKIMS Medical College, Srinagar-190 010, J&K, India.

Received : 07-12-2012     Accepted : 05-09-2013     Published : 30-12-2013
Volume : 1     Issue : 2       Pages : 18 - 25
World Res J Med Sci 1.2 (2013):18-25

<i>Aim:</i> To Evaluate the presence of left ventricular diastolic dysfunction is primary hypothyroidism patients free from diabetes, hypertension, coronary artery disease. The Study comprised of 75 first time diagnosed primary hypothyroid patients (>20 years & <60 years of age) of either sex including hospitalized as well as outdoor patients and matched with 75 healthy subjects as controls. <i>Methodology:</i> After the diagnosis, patients were put on levothyroxine therapy and the TSH and FT4 level were repeated.The subjects were initially divided into hypothyroid patients (Group I) and controls (Group II). Hypothyroid patients (Group I) were further divided according to their diastolic physiology. Group IA (n=17) impaired relaxation, Group IB (n=25) pseudonormal pattern of filling and Group IC (n=33) patients with normal diastolic physiology. None of individuals in our study had restrictive pattern of filling. <i>Results:</i> In our study the hypothyroid patients (Group I), 17 (22.7%) were males and 58 (77.3%) were females. Majority 46 (61.3%) belong to rural areas. TSH, FT4 levels and post valsalva mitral. A wave velocity, E/A ratio and DT were statistically significant between cases and controls. A significant statistical difference between pre and post valsalva maneuver in group A, B and C with regards to mitral inflow velocities, E/A ratio, DT. There was marked improvement in diastolic dysfunction in hypothhroid patients (Group A, B, C) after L-T4 therapy and was statistically significant. There is significant improvement in TSH and FT4 levels after L-T4 therapy. <i>Conclusion:</i> The study demonstrates that asymptomatic LV diastolic dysfunction is present in 56% of hypothyroid patients. Identification of pseudonormal pattern of filling can be easily overlooked if valsalva maneuver is not used to unmask. LV diastolic dysfunction is an early sign of hypothyroid heart disease preceding the systolic dysfunction. This reinforces the importance of routine and repeated doppler echocardiography. After levothyroxine therapy there is significant improvement of LV diastolic dysfunction in hypothyroid patients.