Giorgio Iervasi - Thyroid and Heart: A Comprehensive Translational Essay

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Thyroid disease and cardiovascular disorders are both very common in the general population. The close relationship between the cardiovascular system and the hypothalamus-pituitary-thyroid axis is already well-known for several decades. The successful previous edition of this book, entitledThyroid and Heart Failure: From Pathophysiology to Clinicswas published 10 years ago. Since then, several major breakthroughs unraveling this complex interplay have been made, thereby expanding our pathophysiological and clinical knowledge and opening a new area for therapeutic interventions.

Therefore this book,Thyroid and Heartcomes at the right time. Not only have the editors updated the book with current state-of-the-art evidence, but they also included novel relevant topics that have emerged in the last 10 years. In order to do so, they received help from a large set of world-leading experts in the field.

The book starts with a historical background and the basic mechanisms underlying thyroid hormone action in the developing and mature heart in Chap.discusses the current evidence and future perspectives of the potential role of thyroid hormone (and its analogs) for the treatment of cardiovascular disease.

There are no other textbooks currently available on this topic that have a similar multidisciplinary perspective. The book is easy to read and offers an excellent overview of the clinical, pathophysiological, and basic science aspects of the interaction of the thyroid and the heart. Altogether, the editors ofThyroid and Hearthave done a great job with this updated book which provides important novel mechanistic insights for both clinicians and experimental scientists and will therefore be of great interest to a large audience of readers.

Although the seminal work of Parry CH. (Elements of Pathology and Therapeutics, Being the Outlines of a Work. Bath, England: R. Cruttwell, 1815) and the original description of Graves disease were reported in the eighteenth century, the awareness of the scientific community to the strong and dangerous liaison existing between thyroid and the heart dates back to the 1980s, when a few pioneering studies reported that even minimal abnormalities of thyroid function (such as subclinical hypothyroidism or hyperthyroidism, and low triiodothyronine syndrome) were associated with increased cardiovascular morbidity and mortality. It has been proven for decades that the action of thyroid hormones is carried out in a pleiotropic manner on a large number of organs and tissues, and specifically, thyroid hormone receptors are present on the endothelial and myocardial tissues. Therefore, checking for thyroid hormone abnormalities is nowadays routinely performed by cardiologists, due to the dismal effect of such abnormalities if left untreated, and also because results of preliminary randomized controlled trials employing thyroid hormone replacement therapy suggesting a degree of safety and efficacy. Thyroid hormone abnormalities play an even more relevant role when placed in the framework of multiple anabolic deficits in heart failure with the intriguing possibility to implement a therapeutic replacement regimen consisting of multiple hormones.

From a cardiologists perspective, as recently pointed out by an ad hoc working group created by the NHBLI with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease, the fundamental areas of interest in this exciting field include: investigations into the biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormones or thyromimetic drugs. All such topics are covered by the current essay, timely edited byPingitore and Iervasi, that draws a roadmap of the important existing relationship between THYROID AND HEART, and consequently, is very likely to grant a remarkable benefit to the medical community.Thyroid hormones play a central role in the development of the cardiovascular system during fetal life, as outlined byRutigliano Gin her appraisal. Genetics do also matter with regard to the regulation of thyroid function and cardiovascular risk factors, as pointed out byKu and coworkersin their chapter. Among cardiovascular risk factors, the role of thyroid hormones in blood pressure control is remarkable, and accordingly this topic is extensively addressed in the chapter written byJabbar and Razvi. Subclinical hypothyroidism must nowadays be considered a major cardiovascular risk factor, bearing in mind its clear association with diastolic dysfunction, lipid abnormalities, and especially the increased cardiovascular mortality, as documented by