Rethinking strategies for solving thyroid dysfunction at the heart of cardiovascular disease

Throughout a person's lifetime, thyroid hormones (THs) have an outsized impact on cardiovascular health from prenatal heart development to adult cardiac contractile function and blood pressure regulation. Maintaining a healthy functioning hypothalamic-thyroid axis is crucial for preventing cardiac-related and all-cause mortality. Patients with moderate to severe heart failure (HF) often manifest with low or borderline-low TH function. In this review article, we examine the potential of TH therapy in HF management by highlighting outcomes from recent clinical studies. We also address the need for a serum-based biomarker such as brain natriuretic peptide (BNP) that indicates disease stage of HF and that also correlates with cardiac tissue TH status. Recent and newer therapeutic strategies (including the combination of Triiodothyronine and Thyroxine) to advance the management of patients living with HF are proposed including a reassessment of what is normal thyroid status in these patients and the potential of TH treatment.