The Relationship between Thyroid Hormone Levels and Corrected QT Interval and QT Dispersion in Non-Diabetic Hemodialysis Patients


Background: Cardiovascular disease and sudden cardiac death are common in hemodialysis patients. These cardiac complications are often associated with prolonged QTc interval (QTc) and QTc dispersion (QTcd). Subclinical hypothyroidism (SH) can alter autonomic modulation of heart rate and cause increased inhomogeneity of ventricular recovery time. We aimed to evaluate the relationship between thyroid hormone levels and QTc and QTcd in non-diabetic hemodialysis patients. Methods: We enrolled 29 non-diabetic hemodialysis patients without thyroid disease. After each hemodialysis session, a 12-lead ECG was recorded. Before each hemodialysis session, routine laboratory tests and measurement of thyroid hormone levels were performed. Patients were divided into 2 groups according to QTc (group 1 QTc < 430 ms, group 2 QTc ≥ 430 ms). We examined the relationship between QTc or QTcd and thyroid hormone in the respective groups and then compared the results from the 2 groups. Results: The mean age was 54.06 ± 14.72 years and the means of QTc and QTcd were 433.82 ± 22.03 ms, 59.10 ± 28.29 ms, respectively. Homocysteine levels were significant higher in group 2 than group 1 (p < 0.05) and QTcd was comparable between groups. In group 1, QTc and QTcd were not significant correlated with TSH, T3, fT4 and biochemical parameters. In group 2, QTc was significant positively correlated with TSH (p < 0.05) and QTcd was not significant correlated with thyroid hormone levels. Conclusion: The results of this study showed that TSH is associated with prolonged QTc interval and hyperhomocysteinemia in non-diabetic hemodialysis patients. Moreover, we suggest that SH may be associated with prolonged QTc in non-diabetic hemodialysis patients. However, further studies are required to elucidate the role of the L-thyroxine doses and TSH target levels in hemodialysis patients.

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H. Kim, J. Kim, S. Suh, Y. Hyun, K. Mi Park and H. Kim, "The Relationship between Thyroid Hormone Levels and Corrected QT Interval and QT Dispersion in Non-Diabetic Hemodialysis Patients," Open Journal of Nephrology, Vol. 4 No. 1, 2014, pp. 13-19. doi: 10.4236/ojneph.2014.41003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Jardine, A.G. and McLaughlin, K. (2001) Cardiovascular Complications of Renal Disease. Heart, 86, 459-466.
[2] Althaus, B.U., Staub, J.J., Ryff-De Leche, A., Oberhansli, A. and Stahelin, H.B. (1988) LDL/HDL-Changes in Subclinical Hypothyroidism: Possible Risk Factors for Coronary Heart Disease. Clinical Endocrinology (Oxford), 28, 157-163.
[3] Monzani, F., Caraccio, N., Kozakowa, M., Dardano, A., Vittone, F., Virdis, A., et al. (2004) Effect of Levothyroxine Replacement on Lipid Profile and Intima-Media Thickness in Subclinical Hypothyroidism: A Double-Blind, Placebo-Controlled Study. The Journal of Clinical Endocrinology & Metabolism, 89, 2099-2106.
[4] Hak, A.E., Pols, H.A., Visser, T.J., Drexhage, H.A., Hofman, A. and Witteman, J.C. (2000) Subclinical Hypothyroidism Is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study. Annals of Internal Medicine, 132, 270-278.
[5] Galetta, F., Franzoni, F., Fallahi, P., Rossi, M., Carpi, A., Rubello, D., et al. (2006) Heart Rate Variability and QT Dispersion in Patients with Subclinical Hypothyroidism. Biomedicine & Pharmacotherapy, 60, 425-430.
[6] Schouten, E.G., Dekker, J.M., Meppelink, P., Kok, F.J., Vandenbroucke, J.P. and Pool, J. (1991) QT interval Prolongation Predicts Cardiovascular Mortality in an Apparently Healthy Population. Circulation, 84, 1516-1523.
[7] Schwartz, P.J. and Wolf, S. (1978) QT Interval Prolongation as Predictor of Sudden Death in Patients with Myocardial Infarction. Circulation, 57, 1074-1077.
[8] Batchvarov, V. and Malik, M. (2000) Measurement and Interpretation of QT Dispersion. Progress in Cardiovascular Diseases, 42, 325-344.
[9] Port, F.K. (1994) Morbidity and Mortality in Dialysis Patients. Kidney International, 46, 1728-1737.
[10] Brown, J.H., Hunt, L.P., Vites, N.P., Short, C.D., Gokal, R. and Mallick, N.P. (1994) Comparative Mortality from Cardiovascular Disease in Patients with Chronic Renal Failure. Nephrology Dialysis Transplantation, 9, 1136-1142.
[11] Zaidi, M., Robert, A., Fesler, R., Derwael, C. and Brohet, C. (1997) Dispersion of Ventricular Repolarisation: A Marker of Ventricular Arrhythmias in Patients with Previous Myocardial Infarction. Heart, 78, 371-375.
[12] Algra, A., Tijssen, J.G., Roelandt, J.R., Pool, J. and Lubsen, J. (1993) Heart Rate Variability from 24-Hour Electrocardiography and the 2-Year Risk for Sudden Death. Circulation, 88, 180-185.
[13] Tsuji, H., Larson, M.G., Venditti Jr., F.J., Manders, E.S., Evans, J.C., Feldman, C.L., et al. (1996) Impact of Reduced Heart Rate Variability on Risk for Cardiac Events. The Framingham Heart Study. Circulation, 94, 2850-2855.
[14] Balanescu, S., Galinier, M., Fourcade, J., Dorobantu, M., Albenque, J.P., Massabuau, P., et al. (1996) Correlation between QT Interval Dispersion and Ventricular Arrhythmia in Hypertension. Archives des Maladies du Coeur et des Vaisseaux, 89, 987-990.
[15] Bakiner, O., Ertorer, M.E., Haydardedeoglu, F.E., Bozkirli, E., Tutuncu, N.B. and Demirag, N.G. (2008) Subclinical Hypothyroidism Is Characterized by Increased QT Interval Dispersion among Women. Medical Principles and Practice, 17, 390-394.
[16] Hii, J.T., Wyse, D.G., Gillis, A.M., Duff, H.J., Solylo, M.A. and Mitchell, L.B. (1992) Precordial QT Interval Dispersion as a Marker of Torsade de Pointes. Disparate Effects of Class Ia Antiarrhythmic Drugs and Amiodarone. Circulation, 86, 1376-1382.
[17] Yunus, A., Gillis, A.M., Duff, H.J., Wyse, D.G. and Mitchell, L.B. (1996) Increased Precordial QTc Dispersion Predicts Ventricular Fibrillation during Acute Myocardial Infarction. American Journal of Cardiology, 78, 706-708.
[18] Zareba, W., Moss, A.J. and le Cessie, S. (1994) Dispersion of Ventricular Repolarization and Arrhythmic Cardiac Death in Coronary Artery Disease. American Journal of Cardiology, 74, 550-553.
[19] Naas, A.A., Davidson, N.C., Thompson, C., Cummings, F., Ogston, S.A., Jung, R.T., et al. (1998) QT and QTc Dispersion Are Accurate Predictors of Cardiac Death in Newly Diagnosed Non-Insulin Dependent Diabetes: Cohort Study. BMJ, 316, 745-746.
[20] Kweon, K.H., Park, B.H. and Cho, C.G. (2007) The Effects of L-Thyroxine Treatment on QT Dispersion in Primary Hypothyroidism. Journal of Korean Medical Science, 22, 114-116.
[21] de Bruyne, M.C., Hoes, A.W., Kors, J.A., Hofman, A., van Bemmel, J.H. and Grobbee, D.E. (1998) QTc Dispersion Predicts Cardiac Mortality in the Elderly: The Rotterdam Study. Circulation, 97, 467-472.
[22] Okin, P.M., Devereux, R.B., Howard, B.V., Fabsitz, R.R., Lee, E.T. and Welty, T.K. (2000) Assessment of QT Interval and QT Dispersion for Prediction of All-Cause and Cardiovascular Mortality in American Indians: The Strong Heart Study. Circulation, 101, 61-66.
[23] Somberg, J.C. and Molnar, J. (2002) Usefulness of QT Dispersion as an Electrocardiographically Derived Index. American Journal of Cardiology, 89, 291-294.
[24] Lien, E.A., Nedrebo, B.G., Varhaug, J.E., Nygard, O., Aakvaag, A. and Ueland, P.M. (2000) Plasma Total Homocysteine Levels during Short-Term Iatrogenic Hypothyroidism. The Journal of Clinical Endocrinology & Metabolism, 85, 1049-1053.
[25] Nedrebo, B.G., Nygard, O., Ueland, P.M. and Lien, E.A. (2001) Plasma Total Homocysteine in Hyper- and Hypothyroid Patients before and during 12 Months of Treatment. Clinical Chemistry, 47, 1738-1741.
[26] Chadarevian, R., Bruckert, E., Leenhardt, L., Giral, P., Ankri, A. and Turpin, G. (2001) Components of the Fibrinolytic System Are Differently Altered in Moderate and Severe Hypothyroidism. The Journal of Clinical Endocrinology & Metabolism, 86, 732-737.
[27] Welch, G.N. and Loscalzo, J. (1998) Homocysteine and Atherothrombosis. The New England Journal of Medicine, 338, 1042-1050.
[28] Cakal, B., Cakal, E., Demirbas, B., Ozkaya, M., Karaahmetoglu, S., Serter, R., et al. (2007) Homocysteine and Fibrinogen Changes with L-Thyroxine in Subclinical Hypothyroid Patients. Journal of Korean Medical Science, 22, 431-435.
[29] Turhan, S., Sezer, S., Erden, G., Guctekin, A., Ucar, F., Ginis, Z., et al. (2008) Plasma Homocysteine Concentrations and serum Lipid Profile as Atherosclerotic Risk Factors in Subclinical Hypothyroidism. Annals of Saudi Medicine, 28, 96-101.

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