Skip to main content

Advertisement

SpringerLink
Log in

Thyroid hormone and blood pressure regulation

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Thyroid hormone has well-recognized effects on the cardiovascular system and blood pressure regulation. Blood pressure is altered across the entire spectrum of thyroid disease. The effects of hyperthyroidism include increased cardiac output, contractility, tachycardia, widened pulse pressure, decreased systemic vascular resistance, and increased basal metabolic rate. The manifestations of hypothyroidism are in marked contrast to those of hyperthyroidism and include decreased cardiac output, narrow pulse pressure, increased systemic vascular resistance, and decreased metabolic rate. Although thyroid hormone affects almost all tissues of the body and mediates changes in homeostasis, adaptations of the cardiovascular system can result in changes in blood pressure to accommodate the new demands on the system. In this paper, we review the direct and indirect thyroid hormone-mediated effects on blood pressure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Dernellis J, Panaretou M: Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism. Am Heart J 2002, 143:718–724.

    Article  PubMed  CAS  Google Scholar 

  2. Klein I, Ojamaa K: Thyroid hormone and blood pressure regulation. In Hypertension: Pathophysiology, Diagnosis and Management. Edited by Laragh JH, Brenner BM. New York: Raven Press; 1995:2247–2262.

    Google Scholar 

  3. Fletcher AK, Weetman AP: Hypertension and hypothyroidism. J Hum Hypertens 1998, 12:79–82.

    Article  PubMed  CAS  Google Scholar 

  4. Parry CH: Collections from the unpublished papers of the late Caleb Hilliel Parry. Dis Heart 1825, 2:111–165.

    Google Scholar 

  5. Anderson GW, Mariash CN, Oppenheimer JH: Molecular actions of thyroid hormone. In Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text, edn 8. Edited by Braverman LE, Utiger RD. Philadelphia: Lippincott, Williams & Wilkins; 2000:174–195.

    Google Scholar 

  6. Klein I, Ojamaa K: Thyroid hormone and the cardiovascular system. N Engl J Med 2001, 344:501–509. An overall discussion of the cardiovascular actions of thyroid hormone with specific emphasis on the diagnosis and treatment of both hypothyroidism and hyperthyroidism.

    Article  PubMed  CAS  Google Scholar 

  7. Levey GS, Klein I: Disorders of the thyroid. In Internal Medicine, edn 5. Edited by Stein JH. St. Louis: Mosby; 1998:1323–1349.

    Google Scholar 

  8. Zhang J, Lazar MA: The mechanism of action of thyroid hormones. Annu Rev Physiol 2000, 62:439–466.

    Article  PubMed  CAS  Google Scholar 

  9. Mintz G, Pizzarello R, Klein I: Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment. J Clin Endocrinol Metab 1991, 73:146–150.

    PubMed  CAS  Google Scholar 

  10. Koss KL, Kranias EG: Phospholamban: a prominent regulator of myocardial contractility. Circ Res 1996, 79:1059–63.

    PubMed  CAS  Google Scholar 

  11. Davis PJ, Davis FB: Nongenomic actions of thyroid hormone on the heart. Thyroid 2002, 12:459–466.

    Article  PubMed  CAS  Google Scholar 

  12. Klein I: Clinical, metabolic, and organ-specific indices of thyroid function. In Endocrinology and Metabolism Clinics, vol 30. Edited by Ross DS. Philadelphia: WB Saunders; 2001:415–427.

    Google Scholar 

  13. Goglia F, Silvestri E, Lanni A: Thyroid hormones and mitochondria. Biosci Rep 2002, 22:17–32.

    Article  PubMed  CAS  Google Scholar 

  14. Wrutniak-Cabello C, Casas F, Cabello G: Thyroid hormone action in mitochondria. J Mol Endocrinol 2001, 26:67–77.

    Article  PubMed  CAS  Google Scholar 

  15. Mutvei A, Husman B, Andersson G, et al.: Thyroid hormone and not growth hormone is the principal regulator of mammalian mitochondrial biogenesis. Acta Endocrinologica 1989, 121:235–228.

    Google Scholar 

  16. Klein I: Thyroid hormone and the cardiovascular system. Am J Med 1990, 88:631–637.

    Article  PubMed  CAS  Google Scholar 

  17. Polikar R, Burger AG, Scherrer U, et al.: The thyroid and the heart. Circulation 1993, 87:1435–1441.

    PubMed  CAS  Google Scholar 

  18. Biondi B, Palmieri EA, Lombardi G, et al.: Effects of thyroid hormone on cardiac function: the relative importance of heart rate, loading conditions, and myocardial contractility in the regulation of cardiac performance in human hyperthyroidism. J Clin Endocrinol Metab 2002, 87:968–974. A review of the changes in hemodynamic loading, both preload and afterload, as it effects the cardiovascular response to thyroid disease.

    Article  PubMed  CAS  Google Scholar 

  19. Graettinger JS, Muenster JJ, Selverstone LA, et al.: A correlation of clinical and hemodynamic studies in patients with hyperthyroidism with and without congestive heart failure. J Clin Invest 1959, 38:1316–1327.

    PubMed  CAS  Google Scholar 

  20. Graettinger JS, Muenster JJ, Checchia CS, et al.: A correlation of clinical and hemodynamic studies in patients with hypothyroidism. J Clin Invest 1957, 37:502–510.

    Google Scholar 

  21. Obuobie K, Smith J, Evans LM, et al.: Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab 2002, 87:4662–4666.

    Article  PubMed  CAS  Google Scholar 

  22. Park KW, Kai HB, Ojamaa K, et al.: The direct vasomotor effect of thyroid hormones on rat skeletal muscle resistance arteries. Anesth Analg 1997, 85:734–738. A study of the mechanisms by which T3 acts as a novel vasodilator.

    Article  PubMed  CAS  Google Scholar 

  23. Giannattasio C, Rivolta MR, Failla M, et al.: Large and medium sized artery abnormalities in untreated and treated hypothyroidism. Eur Heart J 1997, 18:1492–1498.

    PubMed  CAS  Google Scholar 

  24. Napoli R, Biondi B, Guardasole V, et al.: Impact of hyperthyroidism and its correction on vascular reactivity in humans. Circulation 2001, 104:3076–3080.

    PubMed  CAS  Google Scholar 

  25. Toft AD, Boon NA: Thyroid disease and the heart. Heart 2000, 84:455–460.

    Article  PubMed  CAS  Google Scholar 

  26. Villabona C, Sahun M, Roca M, et al.: Blood volumes and renal function in overt and subclinical primary hypothyroidism. Am J Med Sci 1999, 318:277–280.

    Article  PubMed  CAS  Google Scholar 

  27. Buccino RA, Spann JF, Pool PE, et al.: Influence of the thyroid state on the intrinsic contractile properties and energy stores of the myocardium. J Clin Invest 1967, 46:1669–1682.

    PubMed  CAS  Google Scholar 

  28. Amidi M, Leon DF, deGroot J, et al.: Effect of the thyroid state on myocardial contractility and ventricular ejection rate in man. Circulation 1968, 38:229–239.

    PubMed  CAS  Google Scholar 

  29. Ojamaa K, Sabet A, Kenessey A, et al.: Regulation of rat cardiac Kv1.5 gene expression by thyroid hormone is rapid and chamber specific. Endocrinology 1999, 140:3170–3176.

    Article  PubMed  CAS  Google Scholar 

  30. Klein I, Hong C: Effects of thyroid hormone on cardiac size and myosin content of the heterotopically transplanted rat heart. J Clin Invest 1986, 77:1694–1698.

    PubMed  CAS  Google Scholar 

  31. Sugden PH, Clerk A: Cellular mechanisms of cardiac hypertrophy. J Mol Med 1998, 76:725–746.

    Article  PubMed  CAS  Google Scholar 

  32. Coleman PS, Parmacek MS, Lesch M, et al.: Protein synthesis and degradation during regression of thyroxine-induced cardiac hypertrophy. J Mol Cell Cardiol 1989, 21:911–925.

    Article  PubMed  CAS  Google Scholar 

  33. Klein I: Thyroxine-induced cardiac hypertrophy: time course of development and inhibition by propranolol. Endocrinology 1988, 123:203–210.

    PubMed  CAS  Google Scholar 

  34. Biondi B, Palmieri EA, Fazio S, et al.: Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab 2000, 85:4701–4705.

    Article  PubMed  CAS  Google Scholar 

  35. Parle JV, Maisonneuve P, Shepard MC, et al.: Prediction of allcause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001, 358:861–865.

    Article  PubMed  CAS  Google Scholar 

  36. Savage DD, Levy D, Dannenberg AL, et al.: Association of echocardiographic left ventricular mass with body size, blood pressure and physical activity (the Framingham Study). Am J Cardiol 1990, 65:371–376.

    Article  PubMed  CAS  Google Scholar 

  37. Levy D, Garrison RJ, Savage DD, et al.: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990, 322:1561–1566.

    Article  PubMed  CAS  Google Scholar 

  38. Ventrella SM, Klein I: Beta-adrenergic receptor blocking drugs in the management of hyperthyroidism. Endocrinologist 1994, 4:391–399.

    Google Scholar 

  39. Ojamaa K, Klein I, Sabet A, et al.: Changes in adenylyl cyclase isoforms as a mechanism for thyroid hormone modulation of cardiac beta-adrenergic receptor responsiveness. Metabolism 2000, 49:275–279.

    Article  PubMed  CAS  Google Scholar 

  40. Hoit BD, Khoury SF, Shao Y, et al.: Effects of thyroid hormone on cardiac b-adrenergic responsiveness in conscious baboons. Circulation 1997, 96:592–598.

    PubMed  CAS  Google Scholar 

  41. Stevenson LW: Beta-blockers for stable heart failure. N Engl J Med 2002, 346:1346–1347.

    Article  PubMed  Google Scholar 

  42. Rockman HA, Koch WJ, Lefkowitz RJ: Cardiac function in genetically engineered mice with altered adrenergic receptor signaling. Am J Physiol Heart Circ Physiol 1997, 272:H1553-H1559.

    CAS  Google Scholar 

  43. Resnick LM, Laragh JH: Plasma renin activity in syndromes of thyroid hormone excess and deficiency. Life Sci 1982, 30:585–588.

    Article  PubMed  CAS  Google Scholar 

  44. Kobori H, Hayashi M, Saruta T: Thyroid hormone stimulates renin gene expression through the thyroid hormone response element. Hypertension 2001, 37:99–104.

    PubMed  CAS  Google Scholar 

  45. Marcisz C, Jonderko G, Kucharz EJ: Influence of short-time application of a low sodium diet on blood pressure in patients with hyperthyroidism or hypothyroidism during therapy. Am J Hypertens 2001, 14:995–1002.

    Article  PubMed  CAS  Google Scholar 

  46. Durocher D, Grepin C, Nemer M: Regulation of gene expression in the endocrine heart. Recent Prog Horm Res 1998, 53:7–23.

    PubMed  CAS  Google Scholar 

  47. Lewicki JA, Protter AA: Physiological studies of the natriuretic peptide family. In Hypertension: Pathophysiology, Diagnosis and Management. Edited by Laragh JH, Brenner BM. New York: Raven Press; 1995:1029–1053.

    Google Scholar 

  48. Argentin S, Drouin J, Nemer M: Thyroid hormone stimulates rat pro-natriodilantin mRNA levels in primary cardiocyte cultures. Biochem Biophys Res Commun 1987, 146:1336–1341.

    Article  PubMed  CAS  Google Scholar 

  49. Ladenson PW, Bloch KD, Seidman JG: Modulation of atrial natriuretic factor by thyroid hormone: messenger ribonucleic acid and peptide levels in hypothyroid, euthyroid, and hyperthyroid rat atria and ventricles. Endocrinology 1988, 123:652–657.

    PubMed  CAS  Google Scholar 

  50. Vesely DL: Atrial natriuretic peptide prohormone gene expression: hormones and diseases that upregulate its expression. IUBMB Life 2002, 53:153–159.

    Article  PubMed  CAS  Google Scholar 

  51. Liang F, Webb P, Marimuthu A, et al.: Triiodothyronine increases brain natriuretic peptide (BNP) gene transcription and amplifies endothelin-dependent bnp gene transcription and hypertrophy in neonatal rat ventricular myocytes. J Biol Chem 2003, 278:15073–15083.

    Article  PubMed  CAS  Google Scholar 

  52. Cesareo R, Tarabuso A, Di Benedetto M, et al.: Plasmatic endothelin-1 levels in hyperthyroid patients before and after antithyroid therapy. Minerva Endocrinol 2000, 25:1–3.

    PubMed  CAS  Google Scholar 

  53. Tilly N, Schneider JG, Leidig-Bruckner G, et al.: Endothelin-1 levels in patients with disorders of the thyroid gland. Exp Clin Endocrinol Diabetes 2003, 111:80–84.

    Article  PubMed  CAS  Google Scholar 

  54. Lam HC, Lee JK, Lai KH, et al.: Plasma endothelin levels are unaltered by thyroid hormone status in humans. J Cardiovasc Pharmacol 2000, 36:S382-S385.

    PubMed  CAS  Google Scholar 

  55. Baumgartner-Parzer SM, Wagner L, Reining G, et al.: Increase by tri-iodothyronine of endothelin-1, fibronectin and von Willebrand factor in cultured endothelial cells. J Endocrinol 1997, 154:231–239.

    Article  PubMed  CAS  Google Scholar 

  56. Imai T, Hirata Y, Iwashina M, et al.: Hormonal regulation of rat adrenomedullin gene in vasculature. Endocrinology 1995, 136:1544–1548.

    Article  PubMed  CAS  Google Scholar 

  57. Isumi Y, Shoji H, Sugo S, et al.: Regulation of adrenomedullin production in rat endothelial cells. Endocrinology 1998, 139:838–846.

    Article  PubMed  CAS  Google Scholar 

  58. Tomoda Y, Kikumoto K, Isumi Y, et al.: Cardiac fibroblasts are major production and target cells of adrenomedullin in the heart in vitro. Cardiovasc Res 2001, 49:721–730.

    Article  PubMed  CAS  Google Scholar 

  59. Taniyama M, Kitamura K, Ban Y, et al.: Elevated plasma adrenomedullin level in hyperthyroidism. Eur J Clin Invest 1996, 26:454–456.

    Article  PubMed  CAS  Google Scholar 

  60. Saito I, Kunihiko I, Saruta T: Hypothyroidism as a cause of hypertension. Hypertension 1983, 5:112–115.

    PubMed  CAS  Google Scholar 

  61. Canaris GJ, Manowitz NR, Mayor G, et al.: The Colorado thyroid disease prevalence study. Arch Intern Med 2000, 160:526–534.

    Article  PubMed  CAS  Google Scholar 

  62. Streeten DHP, Anderson GH Jr, Howland T, et al.: Effects of thyroid function on blood pressure: recognition of hypothyroid hypertension. Hypertension 1988, 11:78–83.

    PubMed  CAS  Google Scholar 

  63. Attarian E: Myxedema and hypertension. NY State J Med 1963, 63:2801–2804.

    CAS  Google Scholar 

  64. Endo T, Komiya I, Tsukui T, et al.: Reevaluation of possible high incidence of hypertension in hypothyroid patients. Am Heart J 1979, 98:684–688.

    Article  PubMed  CAS  Google Scholar 

  65. Lerman J, Clark RJ, Means JH: The heart in myxedema: electrocardiograms and roentgen-ray measurements before and after therapy. Ann Intern Med 1933, 6:1251–1271.

    Google Scholar 

  66. Saruta T, Kitajima W, Hayashi M, et al.: Renin and aldosterone in hypothyroidism: relation to excretion of sodium and potassium. Clin Endocrinol 1980, 12:483–489.

    CAS  Google Scholar 

  67. Thompson WO, Dickie LFN, Morris AE, et al.: The high incidence of hypertension in toxic goiter and I myxedema. Endocrinology 1931, 15:265–272.

    Article  Google Scholar 

  68. Watanakunakorn C, Hodges RE, Evans TC: Myxedema: a study of 400 cases. Arch Intern Med 1965, 1161:183–190.

    Google Scholar 

  69. Cappola AR, Ladenson PW: Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003, 88:2438–2444.

    Article  PubMed  CAS  Google Scholar 

  70. Christ-Crain M, Meier C, Guglielmetti M, et al.: Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebocontrolled trial. Atherosclerosis 2003, 166:379–386.

    Article  PubMed  CAS  Google Scholar 

  71. Hak AE, Pols HAP, Visser TJ, et al.: Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000, 132:270–278.

    PubMed  CAS  Google Scholar 

  72. Saito I, Saruta T: Hypertension in thyroid disorders. Endocrinol Metab Clin N Am 1994, 23:379–386.

    CAS  Google Scholar 

  73. Virtanen VK, Saha HHT, Groundstroem KWE, et al.: Thyroid hormone substitution therapy rapidly enhances left-ventricular diastolic function in hypothyroid patients. Cardiology 2001, 96:59–64.

    Article  PubMed  CAS  Google Scholar 

  74. Klein I, Levey GS: The cardiovascular system in thyrotoxicosis. In Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text, edn 8. Edited by Braverman LE, Utiger RD. Philadelphia: Lippincott Williams & Wilkins; 2000:596–604.

    Google Scholar 

  75. Sawin CT, Geller A, Wolf PA, et al.: Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994, 331:1249–1252.

    Article  PubMed  CAS  Google Scholar 

  76. Marvisi M, Brianti M, Marani G, et al.: Hyperthyroidism and pulmonary hypertension. Respir Med 2002, 96:215–220.

    Article  PubMed  CAS  Google Scholar 

  77. Curnock AL, Dweik RA, Higgins BH, et al.: High prevalence of hypothyroidism in patients with primary pulmonary hypertension. Am J Med Sci 1999, 318:289–292.

    Article  PubMed  CAS  Google Scholar 

  78. Yanai-Landau H, Amital H, Bar-Dayan Y, et al.: Autoimmune aspects of primary pulmonary hypertension. Pathobiology 1995, 63:71–75.

    Article  PubMed  CAS  Google Scholar 

  79. Thurnheer R, Jenni R, Russi EW, et al.: Hyperthyroidism and pulmonary hypertension. J Intern Med 1997, 242:185–188.

    Article  PubMed  CAS  Google Scholar 

  80. Petkov V, Mosgoeller W, Ziesche R: Vasoactive intestinal peptide as a new drug for treatment of pulmonary hypertension. J Clin Invest 2003, 111:1339–1346.

    Article  PubMed  CAS  Google Scholar 

  81. Henning RJ, Sawmiller DR: Vasoactive intestinal peptide: cardiovascular effects. Cardiovasc Res 2001, 27–37.

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and The Department of Medicine, North Shore University Hospital/NYU School of Medicine, 350 Community Drive, 11030, Manhasset, NY, USA

    Sara Danzi PhD & Irwin Klein MD

Authors
  1. Sara Danzi PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irwin Klein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Danzi, S., Klein, I. Thyroid hormone and blood pressure regulation. Current Science Inc 5, 513–520 (2003). https://doi.org/10.1007/s11906-003-0060-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-003-0060-7

Keywords

Search

Navigation