And cured with T4: this is a case report, titledHypothyroidism-induced reversible dilated cardiomyopathy; ,
by P Rastogi, A Dua, S Attri, and H Sharma, J Postgrad Med. 2018 Jul-Sep; 64(3): 177–179. doi: 10.4103/jpgm.JPGM_154_17, PMCID: PMC6066629PMID: 29992912 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066629/

This paper reports on a young female with DILATED CARDIOMYOPATHY CAUSED BY HYPOTHYROIDISM and cured with T4.


Interestingly, the authors state (I have paraphrased this, for brevity):
”The heart relies mainly on Triiodothyronine (T3) because there is no significant deiodinase activity inside myocytes: T3 is directly transported into the myocyte”.
They go on, to explain “T3 modulates inotropic and lusitropic properties of the myocardium, myocardial contractility, and vascular function”………….. and
Hypothyroidism can produce bradycardia, impaired contractility, impaired diastolic filling, increased systemic vascular resistance, diastolic hypertension, and endothelial dysfunction.” [6]
Further, they say ………….
“It has also been demonstrated that subclinical (intracellular) Hypothyroidism ** may lead to heart failure.”
“Studies have shown that as in the sick-euthyroid syndrome **, which occurs in nonthyroidal illnesses like sepsis, patients with heart failure who have normal thyroid gland may have low levels of T3 with normal T4 and TSH”.
“Low serum T3 in these patients strongly predicts all-cause and cardiovascular mortality”.[7] “The most consistent cardiac abnormality recognized in patients with overt hypothyroidism is impairment of LV diastolic function characterized by slowed myocardial relaxation and impaired early ventricular filling.”…………

In spite of their recognition of T3 as a prime mover in myocardial function, their appreciation of hypothyroidism as a cause of heart failure and their freely admitted realisation that this lady’s cardiomyopathy was caused by T3 deficiency, they still treated her with T4 instead of T3 !

MESSAGE: ** These terms are synonymous with Functional (INTRACELLULAR) Hypothyroidism and in my opinion prescribing oral, slow-release T3 would not only have corrected the problem more certainly and more quickly, but the short half-life of T3 would have allowed daily reassessment, ongoing monitoring and better control of her life-threatening condition.

Fortunately, the patient recovered due to treatment with T4, thus proving the premise of the title of their paper.

See the page on THYROID HORMONE, for details re. functional, intracellular hypothyroidism.

Published by Dr. Gervais Harry

I am a Toronto-trained Urologist. I practiced in downtown Toronto, from 1977 to 1997, when I went to Saudi Arabia as chief of Urology at the Armed Forces (teaching) hospital in Tabuk. Returning to Toronto in Y2000, I switched to family practice. In 2007, began to prescribe Hormone Restoration Therapy and in 2012, I became a member of the American Academy of Antiaging Medicine [A4M]. I successfully wrote the A4M's written examination in December, 2013 and In May, 2016 I passed the oral examination, for accreditation as a BHRT consultant. In 2014 I began BHRT practice in Collingwood, Ontario and in January, 2017, joined the Stone Tree Naturopathic Clinic. Now I am 82 and have retired, but it seems wasteful to jettison my learning and experience: the medical establishment knows nothing of BHRT / Functonal medicine and I feel obliged to offer my knowledge in the interest of those who are willing to think outside the box. MY QUALIFICATIONS: MB, BS, (from UWI), 1964. LMCC 1969. FRCSC (Urology), 1974. ECFMG 1984. Florida license 1998 [inactive], ABAARM Certification [A4M], 2016. I am a Member of CSAMM [the Canadian Society for Aging and Metabolic Medicine], the OMA&CMA, SUSO, CUA, RCP&S/C. PRACTICE TO DATE: Consultation in Functional Medicine, including assessment of Chronic Fatigue Syndrome, Fibromyalgia, Andropause, Menopause, Teenage and Postpartum Depression/Panic Attacks, Thyroid Hormone malfunction, Infertility, Sexual Dysfunction and “the Undiagnosable”. ALL ARE WELCOME to read, comment or question!

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