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Fatigue in Patients With Coronary Artery Disease: Association With Thyroid Axis Hormones and Cortisol

Bunevicius, Adomas MD; Gintauskiene, Vilte MD; Podlipskyte, Aurelija PhD; Zaliunas, Remigijus MD, PhD; Brozaitiene, Julija MD, PhD; Prange, Arthur J. Jr MD; Bunevicius, Robertas MD, PhD

doi: 10.1097/PSY.0b013e318268e7f0
Original Articles

Objective In people with coronary artery disease, the association between endocrine measures and fatigue is not well understood. We evaluated possible associations of fatigue and exercise capacity with function of adrenal axis and thyroid axis.

Methods Sixty-five men and 18 women (mean age 55 years) attending a rehabilitation program were examined using the Multidimensional Fatigue Inventory, Dutch Exertion Fatigue Scale, and the Hospital Anxiety and Depression Scale. Exercise capacity was measured using a bicycle ergometer procedure. Serum concentrations of free triiodothyronine (T3), free thyroxine (T4), morning cortisol, afternoon cortisol, and change in cortisol concentrations (ΔCortisol) were measured.

Results In univariate regression analysis, lower free T4 concentrations were associated with general and exertion fatigue, lower free T3 concentrations were associated with general and physical fatigue, and lower ΔCortisol was associated with mental fatigue. After adjusting for age, sex, body mass index, hypertension, previous myocardial infarction, heart failure, diabetes, New York Heart Association functional class, depressive symptoms, and anxiety symptoms, lower free T3 concentrations remained associated with physical fatigue (β = −.224, p = .03); lower free T4 concentrations, with exertion fatigue (β = −.219, p = .03); and lower morning cortisol and lower ΔCortisol concentrations, with mental fatigue (β = −.193 [p = .03] and β = −.180 [p =.04], respectively). Exercise capacity was not associated with endocrine factors.

Conclusions In coronary artery disease patients, increased thyroid hormone concentrations are associated with decreased physical fatigue and decreased exertion fatigue, and increased cortisol concentrations with decreased mental fatigue. Exercise capacity is not associated with endocrine factors.

Abbreviations CAD = coronary artery disease

T3 = triiodothyronine

T4 = thyroxine

CFS = chronic fatigue syndrome

ΔCortisol = change in cortisol concentration

HPA = hypothalamic-pituitary-adrenal

TSH = thyroid-stimulating hormone

NYHA = New York Heart Association

MI = myocardial infarction

BMI = body mass index

HADS = Hospital Anxiety and Depression Scale

MFI-20 = Multidimensional Fatigue Inventory

DEFS = Dutch Exertion Fatigue Scale

From the Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania (A.B., V.G., A.P., J.B., R.B.); Departments of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, California (A.B., A.J.P.); and Clinic of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania (R.Z.).

Address correspondence and reprint requests to Adomas Bunevicius, MD, Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7175, Medical School Wing D, Chapel Hill, NC 27599-7175. E-mail:

This work, in part, is being supported by the PONTE project and has been funded by the European Commission’s Seventh Framework Programme under contract number 247945. This manuscript expresses the opinions of the authors and not necessarily those of the European Commission. The European Commission is not liable for any use that may be made of the information contained in this manuscript.

Conflicts of interest: None.

Received for publication August 8, 2012; revision received June 13, 2012.

Copyright © 2012 by American Psychosomatic Society
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