sdü tıp fak derg Medical Journal of Süleyman Demirel University 2602-2109 Süleyman Demirel Üniversitesi Evaluation of thyroid function tests in patients with mitral valve prolapse Türker Yasin Özaydın Mehmet Acar Gürkan Özgül Mustafa Hoşcan Yeşim Varol Ercan Doğan Abdullah Erdoğan Doğan 12 30 2009 16 4 19 23 01 01 2010 Copyright © 1994, Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi 1994 Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi

Mitral valv prolapsuslu hastalarda tiroid fonksiyon testlerinin değerlendirilmesiAmaç: Tiroid bezi ve kalbin embriyolojik olarak yakın bir ilişkisi vardır. Ontojenik gelişimde tiroid ve kalp birlikte göç ederler. Tiroid hastalıklarında meydana gelen kardiyovaküler fonksiyonlardaki değişikliklerin bu yakın ilişkiden dolayı kaynaklanabileceği düşünülmüştür. Kronik lenfositik tiroidit ve Graves hastalığınde MVP insidansının arttığı fakat toksik nodüler guatrda anlamlı değişiklik olmadığı gösterilmiştir. Bilgimize göre Türkiye'de, MVP'li hastalarda tiroid fonksiyonlarının değerlendirildiği bir çalışma bulunmamaktadır. Bu çalışmanın temel amacı, mitral valv prolapsuslu (MVP) hastalarda tiroid fonksiyon testlerinin değerlendirilmesidir. Metod: Çalışmaya, mitral valv prolapsuslu ardışık 58 hasta (32'si kadın; yaş ortalaması 33±10, dağılım 16-68) ve kontrol grubu olarak sağlıklı asemptomatik 35 vaka (26'sı kadın; yaş ortalaması 38±11, dağılım 16-58) alındı. Her iki gruptaki tüm olguların tiroid fonksiyon testlerine bakıldı.Bulgular: Grupların bazal demografik ve klinik özellikleri benzerdi. İki grubun serbest serum triiyodotironin (sT3), serbest tiroksin (sT4) ve tiroid stimulan hormon (TSH) düzeyleri arasında anlamlı fark yoktu. Serum TSH düzeyleri, MVP grubundaki iki (%3) hastada normal sınırın altında iken, kontrol grubundaki tüm olgularda normal idi (p=0.272). Her iki gruptaki tüm hastaların serum serbest T3 ve serbest T4 düzeyleri normal sınırlar arasında idi. Sonuç: Çalışmamızın bulguları, MVP ile hipertiroidizm arasında bir ilişki olmadığını düşündürtmektedir. Bu konunun aydınlatılmasında büyük klinik çalışmalara ihtiyaç vardır.Anahtar kelimeler: mitral valv prolapsusu, tiroid fonksiyon testiAbstractObjective: The thyroid gland and the heart share a close relationship arising in embryology. In ontogeny, the thyroid and heart anlage migrate together. The close physiological relationship is affirmed by predictable changes in cardiovascular function across the entire range of thyroid disease states. The prevalence of MVP is significantly elevated in Graves' disease and chronic lymphocytic thyroiditis, but not in toxic multinoduler goiter. No studies have previously evaluated thyroid function tests in patients with MVP in Turkey. The main objective of this study was to evaluate the thyroid function tests in patients with mitral valve prolapse (MVP). Methods: The study population consisted of 58 consecutive patients (32 women; mean age 33±10 years, range 16 to 68) with MVP and 35 asymptomatic healthy subjects the control group (26 woman; mean age 38±11 years, range 16 to 58). All the subjects in the two groups underwent thyroid function tests.Results: Baseline demographic and clinical characteristics of two groups were similar. There was no significant difference in the serum levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) between the two groups. Serum TSH concentrations were under the lower limit of normal in 2 patients (3%) in the MVP group, however, they were within the normal limits in all the patients with control group (p=0.272). Serum fT3 and fT4 levels were within the normal range in the all patients in the both groups. Conclusion: This finding suggests that there is no relationship between the MVP and hyperthyroidism. Large clinical trials are required to clarify this issue.Key words: mitral valve prolapse, thyroid function test

 mitral valv prolapsusu tiroid fonksiyon testi Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, a n d m a n a g e m e n t . A n n I n t e r n M e d 1989;111(4):305–17. Waller BF, Morrow AG, Maron BJ, et al. Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am Heart J 1982;104(2Pt1):276–88. Devereux RB, Kramer-Fox R, Shear MK, et al. Diagnosis and classification of severity of mitral valve prolapse: methodologic, biologic, and prognostic considerations. Am Heart J. 1987;113(5):1265–80. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 1999;341(1):1–7. Devereux RB, Jones EC, Roman MJ, et al. Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: t h e S t r o n g H e a r t S t u d y. A m J M e d 2001;111(9):679–85. Klein I. Endocrine disorders and cardiovascular 23 disease. In :Zipes DP, Libby P, Bonow RO, Braunwald E. Heart Disease, A textbook of cardiovascular medicine (7th Ed). Philadelphia: Elsevier Saunders; 2005;2051-64. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001 15;344(7):501-9. Dillmann WH. Cellular action of thyroid hormone on the heart. Thyroid. 2002;12(6):447-52. Savage DD, Levy D, Garrison RJ, et al. Mitral valve prolapse in the general population. III. Dysrhythmias: The Framingham Study. Am Heart J 1983;106(3):582–85. Channick BJ, Adlin EV, Marks AD, et al. Hyperthyroidism and mitral valve prolapse. N Engl J Med. 1981;305(9):497–500. Brauman A, Rosenberg T, Gilboa Y, Algom M, Fuchs L, Schlesinger Z. Prevalence of mitral valve prolapse in chronic lymphocytic thyroiditis and nongoitrous hypothyroidism. Cardiology. 1988;75(4):269 –73. Marks AD, Channick BJ, Adlin EV, Kessler RK, Braitman LE, Denenberg BS. Chronic thyroiditis and mitral valve prolapse. Ann Intern Med. 1985;102(4):479–83. Brauman A, Algom M, Gilboa Y, Ramot Y, Stryjer D. Mitral valve prolapse in hyperthyroidism of two different origins. Br Heart J. 1985;53(4):374 –77. Khoo DH, Parma J, Rajasoorya C, Vassart G. A germline mutation of thyrotropin receptor gene associated with thyrotoxicosis and mitral valve prolapse in a Chinese family. J Clin Endocrinol Metab. 1999;84(4):1459–62. Levine RA, Stathogiannis E, Newell JB, et al. Reconsideration of echocardiographic standards for mitral valve prolapse: Lack of association between leaflet displacement isolated to the apical f o u r c h a m b e r v i e w a n d i n d e p e n d e n t echocardiographic evidence of abnormality. J Am Coll Cardiol 1988;11(5):1010–19. Chandraratna PA, Nimalasuriya A, Kawanishi D, Duncan P, Rosin B, Rahimtoola SH. Identification of the increased frequency of cardiovascular abnormalities associated with mitral v a l v e p r o l a p s e b y t w o - d i m e n s i o n a l e c h o c a r d i o g r a p h y . A m J C a r d i o l 1984;54(10):1283–5. Helmcke F, Nanda NC, Hsiung MC, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987;75(1):175–83. Baloch Z, Carayon P, Conte-Devolx B, et al. Guidelines Committee, National Academy of Clinical Biochemistry. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13(1):3-126. The HLA antigens and ABO blood groups in an American Black population with mitral valve prolapse. Kachru RB, Telischi M, Cruz JB, Patel R, Towne WD. Tissue Antigens. 1979;14(3):256- 60. Braun WE, Ronan J, Schacter B, Gardin J, Isner J, Grecek D. HLA antigens in mitral-valve prolapse. Transplant Proc 1977;9(4):1869-71. Kidd A, Okita N, Row VV, Volpe R. The immunologic aspects of Graves' and Hashimoto's diseases. Metabolism 1980;29(2):80-99. Schlant RC, Felner JM, Miklozek CL, Lutz JF, Hurst JW. Mitral valve prolapse. Dis Mon 1980;26(10):1-51. Kahaly G, Erbel R, Mohr-Kahaly S, Zenker G, von Olshausen K, Krause U, et al. Basedow's disease and mitral valve prolapse. Dtsch Med Wochenschr. 1987;112(7):248-53. Alvarado A, Ribeiro JP, Freitas FM, Gross JL. Lack of association between thyroid function and mitral valve prolapse in Graves' disease. Braz J Med Biol Res. 1990;23(2):133-9. Weissel M. Hyperthyroidism and heart. Wien Klin Wochenschr. 2001;113(5):157-61. Evangelopoulou ME, Alevizaki M, Toumanidis S, et al. Mitral valve prolapse in autoimmune thyroid disease: an index of systemic autoimmunity? Thyroid 1999;9(10):973-7. Evangelopoulos ME, Toumanidis S, Sotou D, et al. Mitral valve prolapse in young healthy individuals. An early index of autoimmunity? Lupus. 2009;18(5):436-40.