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Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism

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Abstract

Although muscle metabolism and exercise capacity seem to be affected in patients with subclinical hypothyroidism, there is little evidence indicating improvement of the exercise tolerance due to levothyroxine (L-T4) replacement. The aim of the present study was to verify possible cardiopulmonary changes during exercise in patients with subclinical hypothyroidism on L-T4 replacement with a normal serum TSH for six months. Twenty-three patients with subclinical hypothyroidism were randomized into treated (no.=11) and untreated (no.=12) patients. A cardiopulmonary test was performed with a treadmill, using the modified Balke protocol. Heart rate, oxygen uptake, minute ventilation and other cardiopulmonary parameters were assessed at the 5th minute of exercise. FT4 levels increased while TSH normalized after hormone replacement. Oxygen uptake decreased significantly after hormone replacement (24.1 ±6.3 vs 17.1 ±4.2 ml.kg.min−1; p=0.03). Minute ventilation also showed an enhanced performance in treated patients (28.0±8.1 vs 23.5±5.6 l.min−1; p=0.03), as did the heart rate (128±17 vs 121±17 bpm; p=0.03). There were no changes in the untreated group. The results demonstrate that submaximal cardiopulmonary exercise performance improved after six months of TSH normalization and this improvement can help enhance the ability to carry out daily life activities in patients with subclinical hypothyroidism.

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References

  1. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004, 291: 228–38.

    Article  PubMed  CAS  Google Scholar 

  2. Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002, 137: 904–14.

    Article  PubMed  Google Scholar 

  3. Akbar DH, Ahmed MM, Hijazi NA. Subclinical hypothyroidism in elderly women attending an outpatient clinic. Med Sci Monit 2004, 10: CR229–32.

    PubMed  Google Scholar 

  4. Rodondi N, Aujesky D, Vittinghoff E, Cornuz J, Bauer DC. Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis. Am J Med 2006, 119: 541–51.

    Article  PubMed  Google Scholar 

  5. Dagre AG, Lekakis JP, Papaioannou TG, et al. Arterial stiffness is increased in subjects with hypothyroidism. Int J Cardiol 2005, 103: 1–6.

    Article  PubMed  Google Scholar 

  6. Hamano K, Inoue M. Increased risk for atherosclerosis estimated by pulse wave velocity in hypothyroidism and its reversal with appropriate thyroxine treatment. Endocr J 2005, 52: 95–101.

    Article  PubMed  CAS  Google Scholar 

  7. Monzani F, Caraccio N, Kozàkiwà M, et al. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo-controlled study. J Clin Endocrinol Metab 2004, 89: 2099–106.

    Article  PubMed  CAS  Google Scholar 

  8. Vitale G, Galderisi M, Lupoli GA, et al. Left ventricular myocardial impairment in subclinical hypothyroidism assessed by a new ultrasound tool: pulsed tissue Doppler. J Clin Endocrinol Metab 2002, 87: 4350–5.

    Article  PubMed  CAS  Google Scholar 

  9. Monzani F, Di Bello V, Caraccio N, et al. Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study. J Clin Endocrinol Metab 2001, 86: 1110–5.

    Article  PubMed  CAS  Google Scholar 

  10. Biondi B, Fazio S, Palmieri EA, et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin Endocrinol Metab 1999, 84: 2064–7.

    Article  PubMed  CAS  Google Scholar 

  11. Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev 2005, 26: 704–28.

    Article  PubMed  CAS  Google Scholar 

  12. Riis ALD, Jorgensen JOL, Gjedde S, et al. Whole body and forearm substrate metabolism in hyperthyroidism: evidence of increased basal muscle protein breakdown. Am J Physiol Endocrinol Metab 2005, 288: E1067–73.

    Article  PubMed  CAS  Google Scholar 

  13. Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Recent Prog Horm Res 2004, 59: 31–50.

    Article  PubMed  CAS  Google Scholar 

  14. Caraccio N, Natali A, Sironi A, et al. Muscle metabolism and exercise tolerance in subclinical hypothyroidism: a controlled trial of levothyroxine. J Clin Endocrinol Metab 2005, 90: 4057–62.

    Article  PubMed  CAS  Google Scholar 

  15. Monzani F, Caraccio N, Siciliano G, Manca L, Murri L, Ferrannini E. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J Clin Endocrinol Metab 1997, 82: 3315–8.

    Article  PubMed  CAS  Google Scholar 

  16. Tsurugaya H, Adachi H, Kurabayashi M, Ohshima S, Taniguchi K. Prognostic impact of ventilatory efficiency in heart disease patients with preserved exercise tolerance. Circ J 2006, 70: 1332–6.

    Article  PubMed  Google Scholar 

  17. Jones AM, Carter H. The effect of endurance training on parameters of aerobic fitness. Sports Med 2000, 29: 373–86.

    Article  PubMed  CAS  Google Scholar 

  18. Borg G. Borg’s Perceived Exertion and Pain Scales. Champaign: Human Kinetics, 1998.

    Google Scholar 

  19. Mainenti MRM, Teixeira PFS, Oliveira FP, Vaisman M. Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery. Arq Bras Endocrinol Metabol 2007, 51: 1485–92.

    Article  PubMed  Google Scholar 

  20. Arinzon Z, Zuta A, Peisakh A, Feldman J, Berner Y. Evaluation response and effectiveness of thyroid hormone replacement treatment on lipid profile and function in elderly patients with subclinical hypothyroidism. Arch Gerontol Geriatr 2007, 44: 13–9.

    Article  PubMed  CAS  Google Scholar 

  21. Teixeira PF, Reuters VS, Ferreira MM, et al. Treatment of subclinical hypothyroidism reduces atherogenic lipid levels in a placebo-controlled double-blind clinical trial. Horm Metab Res 2008, 40: 50–5.

    Article  PubMed  CAS  Google Scholar 

  22. Arem R, Rokey R, Kiefe C, Escalante DA, Rodriguez A. Cardiac Systolic and Diastolic Function at Rest and Exercise in Subclinical Hypothyroidism: Effect of Thyroid Hormone Therapy. Thyroid 1996, 6: 397–402.

    Article  PubMed  CAS  Google Scholar 

  23. Kahaly GJ. Cardiovascular and Atherogenic Aspects of Subclinical Hypothyroidism. Thyroid 2000, 10: 665–79.

    Article  PubMed  CAS  Google Scholar 

  24. Brenta G, Mutti LA, Schnitman M, Fretes O, Perrone A, Matute ML. Assessment of left ventricular diastolic function by radionuclide ventriculography at rest and exercise in subclinical hypothyroidism, and its response to L-thyroxine therapy. Am J Cardiol 2003, 91: 1327–30.

    Article  PubMed  CAS  Google Scholar 

  25. Kahaly GJ, Kampmann C, Mohr-Kahaly S. Cardiovascular hemodynamics and exercise tolerance in thyroid disease. Thyroid 2002, 12: 473–81.

    Article  PubMed  Google Scholar 

  26. Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007, 116: 1725–35.

    Article  PubMed  Google Scholar 

  27. Clement K, Viguerie N, Diehn M, et al. In vivo regulation of human skeletal muscle gene expression by thyroid hormone. Genome Res 2002, 12: 281–91.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  28. Razvi S, Ingoe L, Keeka G, Oates C, McMillan C, Weaver JU. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab 2007, 92: 1715–23.

    Article  PubMed  CAS  Google Scholar 

  29. Wasserman K, Hansen JE, Sue DY, Whipp BJ. Principles of Exercise Testing and Interpretation. Philadelphia: Lea & Febiger, 1987.

    Google Scholar 

  30. Steinacker JM, Brkic M, Simsch C, et al. Thyroid hormones, cytokines, physical training and metabolic control. Horm Metab Res 2005, 37: 538–44.

    Article  PubMed  CAS  Google Scholar 

  31. Kanaka-Gantenbein C. The impact of exercise on thyroid hormone metabolism in children and adolescents. Horm Metab Res 2005, 37: 563–5.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Endocrine Clinic, University Hospital Clementino Fraga Filho, Brazil

    M. R. M. Mainenti, P. S. Vigário, P. F. S. Teixeira & M. Vaisman

  2. Physical Education and Sports School/Exercise Physiology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    M. R. M. Mainenti, P. S. Vigário, M. D. L. Maia & F. P. Oliveira

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  1. M. R. M. Mainenti
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  2. P. S. Vigário
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  3. P. F. S. Teixeira
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  4. M. D. L. Maia
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  5. F. P. Oliveira
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  6. M. Vaisman
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Correspondence to M. R. M. Mainenti.

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Mainenti, M.R.M., Vigário, P.S., Teixeira, P.F.S. et al. Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. J Endocrinol Invest 32, 470–473 (2009). https://doi.org/10.1007/BF03346488

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