Endocrine Abstracts (2014) 35 OC1.3 | DOI: 10.1530/endoabs.35.OC1.3

Chronic liothyronine (T3) treatment in stable heart failure patients with low T3 syndrome: A randomised, double-blind, cross-over, placebo-controlled intervention study (The LIHFA study)

Pernille Holmager1, Ulla Schmidt1, Peter Dall Mark1, Helena Dominguez2, Bo Zerahn3, Ilan Raymond4, Caroline Kistorp1, Birte Nygaard1 & Jens Faber1,5

1Department of Medicine, Herlev University Hospital, Herlev, Denmark; 2Department of Cardiology, Herlev University Hospital, Herlev, Denmark; 3Department of Clinical Physiology, Herlev University Hospital, Herlev, Denmark; 4Department of Cardiology, Freder, Frederiksberg, Denmark; 5Faculty of Health, University of Copenhagen, Copenhagen, Denmark.

Background and aim: Low T3 syndrome is associated with a poor prognosis in patients with chronic heart failure (CHF). It is controversial whether T3 treatment is indicated in CHF. A previous study using intravenous infusion of T3 for 72 h suggested a beneficial effect on cardiac performance.

We aimed to evaluate the effect of 13 weeks of T3 treatment in patients with stable CHF on left ventricular ejection fraction (LVEF) compared to placebo.

Material and methods: Oral T3 (median (interquartile range (IQR))) 20 (16.7–35) mg/day vs placebo was given for 13 weeks. T3 dose was regulated by repeated TSH measurements, in order not to render patients hyperthyroid. Inclusion: baseline serumT3 levels ≤1.6 nmol/l, LVEF <45 by echocardiography, fully up-titrated with regard to CHF medicine. LVEF was measured as 3D MultiGAated Acquisition (MUGA) at baseline (week 0), cross-over (week 13) and end of study (week 26).

We included 13 patients (11 men), mean age 73.9 years (6.8 years), serum T3 (median (IQR)) 1.4 nmol/l (1.2–1.4 nmol/l) and LVEF of 43% (40–48%).

Results (median (IQR)): Treatment did not change LVEF compared to placebo (ΔLVEF −1.9% (2.0% (−1.1-6.4%) vs −1.9% (−4.28–7.1%) P=0.33)). LVEF after treatment was not significantly improved compared to LVEF after placebo (46.1% (42.8–51.7%) vs 44.1% (37.4–49.0%) P=0.38). Changes in LVEF from baseline to 13 weeks of treatment were not associated with neither serum T3 baseline level (r=0.29, P=0.32) nor baseline LVEF (r=−0.01, P=0.82). Heart rate did not change either and no new arrhythmias were recorded.

Conclusion: √Liothyronin treatment in 13 weeks did not change systolic function in CHF patients with low T3 syndrome.