Disturbance of micronutrient provision: contribution to the formation of thyrotoxic cardiomyopathy in patients with Graves' disease

• Ludmila V. Kvitkova
• Darya S. Vinichenko
• Svetlana A. Smakotina
• Darya A. Borodkina
• Sergey F. Zinchuk

Abstract

Thyrotoxic cardiomyopathy is one of the most serious complications in patients with Graves' disease (GD). The question of the role of trace elements in the formation of cardiovascular complications (CVC) in patients with GD is still open.

Aims and tasks. Determine the content of zinc, selenium, copper in the hair of patients with moderate and severe severity of GD in the presence or absence of cardiovascular complications: congestive heart failure (CHF) and atrial fibrillation (AF). To establish a relationship between the availability of microelements, the severity of thyrotoxicosis and the development of cardiovascular complications.

Material and methods. 113 women participated with a diagnosis of GD 25-60 years: 54.0% (n=61) with moderate severity of thyrotoxicosis, 46.0% (n=52) - with severe. In the control group there were 37 women 25-60 years old without pathology of the thyroid gland (thyroid gland) and cardiovascular system (CVS). In all patients, the following were determined: in the blood - the level of thyroid-stimulating hormone (TSH), free thyroxine (free T4), the concentration of antibodies to the thyroid-stimulating hormone receptor (TSHR-Ab); in hair - concentration of selenium, zinc, copper; results of an ultrasound examination of the thyroid gland (ultrasound).

Results and discussion. Atrial fibrillation (AF) revealed a deficiency of selenium in 70.9% (n=22), zinc in 77.4% (n=24), copper in 67.7% (n=21) cases, with chronic heart failure (CHF) - selenium deficiency in 76,9% (n=40), zinc - in 82.7% (n=43) and copper - in 76.9% (n=40) cases. In the control group, a selenium deficiency of 15.5% (n=6) (p=0.01), a zinc deficiency of 27.0% (n=10) (p=0.01), a copper deficiency of 10.8% (n=4) (p=0.01) of cases. Using logistic regression, a diagnostic model and a table of CHF risk factors in points were compiled, taking into account the levels of selenium, zinc, copper in the hair. The table makes it possible to determine the degree of risk of heart failure for all patients with GD with a general and high level of development of heart failure. It is recommended to include preparations of selenium, zinc, and copper in the treatment regimen for GD.

Conclusion. The results show that a deficiency of these trace elements increases the likelihood of a severe course of GD, the development of CVC, and needs to be diagnosed and corrected.

Keywords:selenium, zinc, copper, Graves' disease, atrial fibrillation, chronic heart failure

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