Increased stiffness in common carotid artery in hyperthyroid Graves’ disease patients

doi:10.1016/S0753-3322(02)00195-6

Biomedicine & Pharmacotherapy

Volume 56, Issue 5, July 2002, Pages 241-246

https://doi.org/10.1016/S0753-3322(02)00195-6 Get rights and content

Abstract

The present study was undertaken to assess the effect of hyperthyroidism on stiffness in the common carotid artery (CCA) in patients with Graves’ disease (GD) and elucidate the mechanism by which arterial stiffness is increased in hyperthyroidism. The arterial stiffness index beta (stiffness β) was evaluated in the CCA using an ultrasonic phase-locked echo-tracking system. Stiffness β was defined as the logarithm of the ratio of systolic to diastolic blood pressure divided by the fractional diameter increase during the cardiac cycle and thus established as a measure of arterial stiffness uninfluenced by the change in blood pressure. Seventy euthyroid GD patients were measured for CCA stiffness β to determine its relationship to retinal blood flow and plasma levels of vascular injury markers. To investigate the effect of hyperthyroidism, 27 GD patients were measured for changes during antithyroid drug (ATD) therapy in stiffness β and in hemodynamic parameters, retinal blood flow and plasma vascular injury markers. In euthyroid GD patients, stiffness β in the CCA showed a significant and positive correlation with systolic blood pressure and pulse pressure, but not with peripheral blood flow in the central retinal artery. ATD therapy significantly reduced stiffness β from 5.23 ± 2.10 to 4.36 ± 1.48. The fractional reduction of stiffness β during ATD therapy correlated significantly with reductions in pulse pressure and retinal blood flow, but not with the reductions in systolic and mean blood pressure, or any of the plasma injury markers. In summary, the significant increase in stiffness β in the hyperthyroid state may reflect the harmful effect of hyperthyroidism on the arterial wall, which may in turn result from increased stroke volume.

Introduction

Hemodynamic changes in hyperthyroidism are characterized by an increase in cardiac output with a widened pulse pressure 〚1〛, 〚2〛, 〚3〛. Marked fall in peripheral vascular resistance and consequent increase of tissue blood perfusion in hyperthyroid state are explained either by marked vasodilation in the small muscular arteries or by an increased capillary density 〚4〛. Although pulse pressure is dependent on ventricular contraction and arterial stiffness 〚5〛, it is not known how hyperthyroidism affects arterial mechanical properties in the large elastic arteries. The recent development of phase-locked echo-tracking sonography allows easy and reproducible measurement of the distensibility of the walls of the common carotid artery (CCA) as stiffness β 〚6〛, 〚7〛. Stiffness β in the CCA is reported to be higher in patients with diabetes 〚6〛, 〚8〛, hypertension 〚9〛, and coronary heart disease 〚10〛. To monitor changes in peripheral blood flow, pulsatile blood flow in the central retinal artery (CRA) was measured in patients with Graves’ disease (GD) but without clinically overt Graves’ ophthalmopathy (GO) using color Doppler ultrasound imaging 〚6〛, 〚11〛. To monitor vascular endothelial injury, plasma vascular injury markers were measured 〚12〛, 〚13〛, 〚14〛.

To analyze the alterations in vascular function at the large elastic arteries thought to occur in hyperthyroidism, we thus performed serial measurement of arterial wall stiffness in the CCA, blood flow, blood pressure, and various plasma vascular injury markers in hyperthyroid GD patients being treated with antithyroid drugs (ATD).

Section snippets

Patients

GD patients (n = 97) were enrolled in the present study during a 20-month period after written informed consent had been obtained from each patient. Before initiation of ATD treatment, the diagnosis of GD was established by the presence of the symptoms and signs of hyperthyroidism, that is, diffuse goiter, elevated serum levels of free thyroxine (FT4) and free triiodothyronine (FT3), thyroid stimulating hormone (TSH) levels below the normal lower limit and increased thyroid uptake of

Correlations of stiffness β in CCA with other parameters in euthyroid GD patients

The correlation of stiffness β in the CCA with the other parameters was examined in GD patients without clinically overt GO who had been maintained in a euthyroid state for at least 3 months by ATD treatment (n = 70). Stiffness β in the CCA correlated significantly with systolic blood pressure (r = 0.255, P = 0.0275), and pulse pressure (r = 0.241, P = 0.0375), but not with mean blood pressure (r = 0.168, P = 0.1509) or diastolic blood pressure (r = 0.078, P = 0.5062) (Fig. 1). It also showed

Discussion

The main hemodynamic changes in hyperthyroidism are characterized by increases in heart rate, cardiac contractility, cardiac output, and systolic blood pressure, and by decreases in diastolic blood pressure 〚1〛, 〚2〛, 〚3〛, 〚4〛. As a result, cardiac output increases and pulse pressure widens. In euthyroid GD patients, stiffness β in the CCA, which is an index of arterial distensibility, showed a significant and positive correlation with systolic blood pressure and pulse pressure (Fig. 1). Since

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Acute Thyrotoxicosis of Graves Disease Associated with Moyamoya Vasculopathy and Stroke in Latin American Women: A Case Series and Review of the Literature
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Moyamoya disease is a cerebral vasculopathy characterized by stenosis of the terminal internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery. There is an association between moyamoya vasculopathy and Graves disease, primarily in Asian populations. Here, we present the largest series of non-Asian, predominantly Latino patients with moyamoya vasculopathy in the setting of Graves thyrotoxicosis, as well as the largest review of the literature to date.
We retrospectively analyzed patients presenting with stroke in the setting of clinical Graves disease to our institution from 2004 to 2014. Moyamoya vasculopathy was diagnosed by magnetic resonance angiography in all patients.
Eight patients with Graves disease thyrotoxicosis and moyamoya vasculopathy were identified. Six patients were effectively managed with aggressive medical management using antithyroid and antiplatelet medications. No recurrent strokes were noted once thyrotoxicosis was controlled. Intracranial bypass was necessary in 2 patients who failed medical management. Seventy-nine additional cases were reported from the literature. There was no significant difference in clinical improvement between medical therapy alone and medical therapy with neurosurgical prophylaxis (87.0% vs. 88.0%, respectively; P = 0.94).
Moyamoya vasculopathy associated with Graves disease thyrotoxicosis in non-Asian women may be more common than previously thought. In addition, our series suggests that thyrotoxicosis promotes the progression of vasculopathy. Based on our review, there is no significant difference in clinical improvement between proper medical and surgical therapies. Aggressive medical therapy should be considered first-line treatment for moyamoya vasculopathy with Graves thyrotoxicosis, with neurosurgical rescue reserved for medically refractory cases.
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Multivariate logistic regression analysis revealed three independent risk factors of high IMT: higher levels of anti-HCMV antibody (odds ratio [OR] 1.04, p = 0.003), Framingham score (OR 1.14, p = 0.018), and levels of IL-1β (OR 2.96, p = 0.013). Anti-HCMV antibody levels had a significantly positive correlation with max-IMT (r = 0.523, p < 0.001), free T₄ levels (r = 0.315, p = 0.021), and Log(TNF-α) (r = 0.562, p < 0.001) in multivariate correlation analysis.
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There were 1493 MMD patients included in this retrospective study. Among them, there were 16 female and 5 male MMD patients coexisted with Graves’ diseases, and 15 of them were adult patients. Bilateral and unilateral lesions were observed in 18 and 3 cases, respectively. 19 patients show cerebral infarction. 18 patients manifested MMD symptoms when they were in a hyperthyroid state. 17 patients received encephaloduroarteriosynangiosis (EDAS) surgery after antithyroid treatment. There were 20 patients completed 2 and 77 months follow-up. 17 patients had good recovery and the other 3 patients had mild or moderate disability. Post-operative DSA achieved in 8 patients examinations showed good collateral circulation to the brain from superficial temporal artery (STA).
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Citation Excerpt :
Decreased thyroid volume could be a reason for a decreased thyroid artery flow. Furthermore, vascular hypertrophy is associated with increased vascular stiffness and increased stiffness of the carotid arteries reported in patients with hyperthyroid Graves’ disease.12–15 Increased CIMT might merely reflect an adaptive response of the vessel wall to the changes in shear stress and tensile stress.14
One of the cardiovascular effects of hyperthyroidism is increased carotid intima media thickness (CIMT). The aim of this study is to investigate the CIMT in patients with Graves’ hyperthyroidism and the effect of propylthiouracil (PTU) therapy on CIMT.
Twenty-six patients with Graves’ hyperthyroidism and 33 healthy controls were included in the study. CIMT was measured at the right and left external carotid arteries in every patient in both groups. CIMT was measured before and after the PTU therapy in patients with Graves’ hyperthyroidism.
There was a significant difference in CIMT between the group of Graves’ hyperthyroid patients and the control group (0.72 versus 0.55 mm, P < 0.0001) at baseline. Twenty-five of 26 patients with Graves’ disease were followed up for 18 months prospectively. Euthyroidism has been achieved in 21 patients. After 18 months of treatment, CIMT decreased significantly compared with the baseline values [0.84 (0.54–1.3) to 0.72 (0.50–1.2), change 0.12 mm, P < 0.001].
Graves’ hyperthyroidism is associated with atherosclerosis as assessed by CIMT. Treatment of Graves’ hyperthyroidism with PTU decreases the CIMT.

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Original articleIncreased stiffness in common carotid artery in hyperthyroid Graves’ disease patients

Abstract

Introduction

Section snippets

Patients

Correlations of stiffness β in CCA with other parameters in euthyroid GD patients

Discussion

Am J M

Blood Vessel

Eur J Vas Surg

Ultrasound Med Biol

Eur J Vas Surg

Ultrasound Med Biol

J Surg Res

Eur J Vas Surg

The effect of age on blood pressure in hyperthyroidism

J Am Geriatr Soc

Thyroid disease and its treatment: short and long-term consequences

J R Coll Phys (London)

The effect of hyperthyroidism on capillarity and oxidative capacity in rat soleus and gastrocnemius muscles

J Physiol

The arterial pulse. Philadelphia

Impaired retinal artery blood flow in IDDM patients before clinical manifestations of diabetic retinopathy

Diabetes Care

Stiffness indexes of the common carotid and femoral arteries are associated with insulin resistance in NIDDM

Diabetes Care

Pathologic changes in the orbit in progressive exophthalmos with special reference to alterations in extra-ocular muscles and optic disk

Arch Ophthalmol

Non-invasive assessment of the age related changes in stiffness of major branches of the human arteries

Cardiovas Res

Stiffness of systemic arteries in patients with myocardial infarction

Circulation

Original article
Increased stiffness in common carotid artery in hyperthyroid Graves’ disease patients