Evaluation of the efficacy of angiotensin II receptor antagonists (Losartan) on the state of central hemodynamics in patients with thyrotoxicosis syndrome.
Keywords:
thyrotoxicosis, treatment of complicationsAbstract
Purpose of the study– to study the effectiveness of the drug losartan on the state of central hemodynamics in patients with thyrotoxicosis syndrome. Material and methods of research. Clinical data collection was carried out at the City Clinical Hospital No. 1 in Andijan 63 people were examined, including 47 women, 16 men, average age49.2±1.62years (for women -47±1.76years, for men -42±2.6years). Patients with thyrotoxicosis syndrome, depending on the disease, were divided into the following 5 groups: patients with diffuse toxic goiter 50% - DTG- (32 people), multinodular goiter - MUZ-11.6% (7 people), autoimmune thyroiditis - AIT-16.7% (11 people), thyrotoxic adenoma - TA-6.7% (4 people) and mixed toxic goiter - MS-15% (9 people). Research methods – general clinical, biochemical (bilirubin, direct, indirect, ALT, AST, PTI, coagulogram, CRP), hormonal (TSH, free thyroxine, antibodies to thyroid peroxidase, to thyroglobulin and thyrocyte receptors, prolactin in the blood),anthropometric calculations (height (cm), weight (kg), BMI (kg/m2), waist circumference, waist circumference) and instrumental: ECG, echo-ECG, ultrasound of the thyroid gland, internal organs, chest X-ray Research results.The study revealed significant changes that suggest that losartan therapy reverses left ventricular hypertrophy (LVH) and improves its structural characteristics in patients with hyperthyroidism syndrome. Left atrial (LA) dilation was found to be a precursor to LVH. Combined use of losartan demonstrated the ability to significantly reduce the size of the left atrium, which was enlarged in most patients examined. Consequently, the observed statistically significant reduction in LA size from 4.42 ± 0.08 to 3.81 ± 0.09 cm (p < 0.05) can be interpreted as a positive effect of losartan therapy. Conclusions.The inclusion of losartan, an angiotensin II receptor blocker, in combination therapy including beta-blockers and antithyroid drugs, against the background of achieved compensation of thyrotoxicosis, led to regression of left ventricular hypertrophy, restoration of sinus rhythm in 43% of patients and a statistically significant improvement in blood pressure.
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1.Tatarchenko I.P., Pozdnyakova N.V., Petrushin I.A. et al. Results of myocardial revascularization: assessment of electrical and structural-geometric remodeling of the left ventricle in diastolic heart failure // Cardiovascular therapy and prevention.-2011.-№7.-P.33-38.
2.Thyrotoxic cardiomyopathy // Heal-cardio.ru 2017
Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism.//Nat Rev Endocrinol. 2010 Aug;6(8):431-43. doi: 10.1038/nrendo.2010.105.
Brandt F, Green A, Hegedüs L, Brix TH. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality.//Eur J Endocrinol. 2011 Oct;165(4):491-7. doi: 10.1530/EJE-11-0299.
Okosieme OE, Taylor PN, Evans C, Thayer D, Chai A, Khan I, Draman MS, Tennant B, Geen J, Sayers A, French R, Lazarus JH, Premawardhana LD, Dayan CM. Primary therapy of Graves' disease and cardiovascular morbidity and mortality: a linked-record cohort study.//Lancet Diabetes Endocrinol. 2019 Apr;7(4):278-287. doi: 10.1016/S2213-8587(19)30059-2.
Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism.//Eur Thyroid J 2018 Aug;7(4):167-186. doi: 10.1159/000490384.
Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.//Thyroid. 2016 Oct;26(10):1343-1421. doi: 10.1089/thy.2016.0229. Erratum in: Thyroid. 2017 Nov;27(11):1462. doi: 10.1089/thy.2016.0229.correx. Erratum in: Thyroid. 2025 Sep;35(9):1097. doi: 10.1089/thy.2016.0229.correx2.
Moon JH, Yi KH The diagnosis and management of hyperthyroidism in Korea: consensus report of the Korean Thyroid Association //Endocrinology and Metabolism. – 2013. – T. 28. – No. 4. – pp. 275-279.
Brito JP, Schilz S, Singh Ospina N, Rodriguez-Gutierrez R, Maraka S, Sangaralingham LR, Montori VM. Antithyroid Drugs—The Most Common Treatment for Graves' Disease in the United States: A Nationwide Population-Based Study.//Thyroid. 2016 Aug;26(8):1144-5. doi: 10.1089/thy.2016.0222.
Burch HB, Burman KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves' disease.//J Clin Endocrinol Metab. 2012 Dec;97(12):4549-58. doi: 10.1210/jc.2012-2802.
Moon JH, Yi KH. The diagnosis and management of hyperthyroidism in Korea: consensus report of the Korean thyroid association. Endocrinol Metab (Seoul). 2013 Dec;2Slingerland DW, Burrows BA. Long-term antithyroid treatment in hyperthyroidism.//JAMA. 1979 Nov 30;242(22):2408-10. P8(4):275-9. doi: 10.3803/EnM.2013.28.4.275.
Slingerland DW, Burrows BA. Long-term antithyroid treatment in hyperthyroidism.//JAMA. 1979 Nov 30;242(22):2408-10.
Abraham P. et al. Antithyroid drug regimen for treating Graves' hyperthyroidism // Cochrane Database of Systematic Reviews. – 2010. – No. 1.
Mohlin E, Filipsson Nyström H, Eliasson M. Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000-2010.//Eur J Endocrinol. 2014 Feb 4;170(3):419-27. doi: 10.1530/EJE-13-0811
Kim YA, Cho SW, Choi HS, Moon S, Moon JH, Kim KW, Park DJ, Yi KH, Park YJ, Cho BY. The Second Antithyroid Drug Treatment Is Effective in Relapsed Graves' Disease Patients: A Median 11-Year Follow-Up Study.//Thyroid. 2017 Apr;27(4):491-496. doi: 10.1089/thy.2016.0056.
Mazza E, Carlini M, Flecchia D, Blatto A, Zuccarini O, Gamba S, Beninati S, Messina M. Long-term follow-up of patients with hyperthyroidism due to Graves' disease treated with methimazole. Comparison of usual treatment schedule with drug discontinuation vs continuous treatment with low methimazole doses: a retrospective study.//J Endocrinol Invest. 2008 Oct;31(10):866-72. doi: 10.1007/BF03346433.
Selmer C, Olesen JB, Hansen ML, von Kappelgaard LM, Madsen JC, Hansen PR, Pedersen OD, Faber J, Torp-Pedersen C, Gislason GH. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events: a large population study.//J Clin Endocrinol Metab. 2014 Jul;99(7):2372-82. doi: 10.1210/jc.2013-4184.
