# Rethinking strategies for solving thyroid dysfunction at the heart of cardiovascular disease

## TL;DR

This paper explores how thyroid hormone therapy could improve heart failure management and highlights the role of biomarkers in assessing thyroid and heart health.

## Contribution

The paper proposes new therapeutic strategies for heart failure involving thyroid hormones and redefines normal thyroid status in these patients.

## Key findings

- Low thyroid hormone function, even within normal ranges, is linked to worse cardiovascular outcomes.
- Heart-derived BNP levels correlate inversely with serum T3 and the T3/T4 ratio in heart failure patients.
- Improved thyroid hormone formulations and combinations show potential for treating cardiovascular diseases.

## Abstract

Throughout a person’s lifetime, thyroid hormones (THs) have an outsized impact on cardiovascular health from prenatal heart development to adult cardiac contractile function and blood pressure regulation. Maintaining a healthy functioning hypothalamic-thyroid axis is crucial for preventing cardiac-related and all-cause mortality. Patients with moderate to severe heart failure (HF) often manifest with low or borderline-low TH function. In this review article, we examine the potential of TH therapy in HF management by highlighting outcomes from recent clinical studies. We also address the need for a serum-based biomarker such as brain natriuretic peptide (BNP) that indicates disease stage of HF and that also correlates with cardiac tissue TH status. Recent and newer therapeutic strategies (including the combination of Triiodothyronine and Thyroxine) to advance the management of patients living with HF are proposed including a reassessment of what is normal thyroid status in these patients and the potential of TH treatment.

Significant clinical evidence indicates adverse cardiovascular outcomes from low TH function even within reference ranges.

Heart-derived serum biomarker BNP inversely correlates with serum T3 and T3/T4 ratio in failing hearts.

Better bioavailable formulations and combinations of THs show promise in treating CV diseases.