No LVEF Benefit with Thyroid treatment in Patients with Acut
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Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis.

This study aimed to evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. A double-blind, randomized clinical trial was conducted in 6 hospitals in the UK. Patients with acute myocardial infarction including ST-segment elevation and non–ST-segment elevation were recruited.

Results
- Among the 95 participants randomized, the mean age was 63.5 years, 72 were men, and 65 had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L and the mean free thyroxine level was 1.14 ng/dL.
- The primary outcome measurements at 52 weeks were available in 85 patients.
- The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group.
- None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups.
- There were 15 and 18 cardiovascular adverse events in the levothyroxine and placebo groups, respectively.

Conclusively, In this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction.

Source: https://jamanetwork.com/journals/jama/article-abstract/2768464
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