Cardiac manifestations in hyperthyroidism

Navajas, Alberto Navarro; Cruz, José David; Ordoñez, Nicolás Ariza; Giral, Helman; Palmezano, Jorge; Bolívar-Mejía, Adrián; Santana, Quindo; Fernández, Ricardo; Durango, Luisa; Saldarriaga, Clara; Mateus, Juan Camilo; Garnica, Diego; Sarta-García, José Guillermo; Lizcano, Fernando; Tapias, Carlos Andrés

doi:10.31083/j.rcm2304136

Cited by 10 publications

(2 citation statements)

References 126 publications

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“…Our study did not find significant differences in individual outcomes of AMI or stroke. Although direct evidence is lacking, we speculate that our cohort’s relatively younger age distribution may have been associated with the prevalence of atherosclerotic diseases, contributing to divergent associations with heart failure and other MACE outcomes. Our findings are consistent with those of a previous report that thyroidectomy for hyperthyroidism was associated with reduced all-cause mortality.…”

Section: Discussionsupporting

confidence: 93%

MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy

Peng,

Lin,

Lee

et al. 2024

JAMA Netw Open

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ImportanceExcessive thyroid hormones from hyperthyroidism increase cardiovascular risks. Among 3 available treatments for hyperthyroidism, comparisons of long-term outcomes associated with antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism are lacking.ObjectiveTo compare risks of major adverse cardiovascular events (MACE) and all-cause mortality among patients with hyperthyroidism treated with ATDs, RAI, or surgery.Design, Setting, and ParticipantsThis nationwide cohort study used the Taiwan National Health Insurance Research Database. Patients aged 20 years or older with newly diagnosed hyperthyroidism between 2011 and 2020 were enrolled. Treatment groups were determined within 18 months from diagnosis, with follow-up until the development of MACE, death, or the end date of the database, whichever came first. Data were analyzed from October 2022 through December 2023.ExposuresThe ATD group received ATDs only. RAI and surgery groups could receive ATDs before treatment. Anyone who underwent thyroid surgery without RAI was classified into the surgery group and vice versa.Main Outcomes and MeasuresThe primary outcomes included MACE (a composite outcome of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality.ResultsAmong 114 062 patients with newly diagnosed hyperthyroidism (mean [SD] age, 44.1 [13.6] years; 83 505 female [73.2%]), 107 052 patients (93.9%) received ATDs alone, 1238 patients (1.1%) received RAI, and 5772 patients (5.1%) underwent surgery during a mean (SD) follow-up of 4.4 (2.5) years. Patients undergoing surgery had a significantly lower risk of MACE (hazard ratio [HR] = 0.76; 95% CI, 0.59-0.98; P = .04), all-cause mortality (HR = 0.53; 95% CI, 0.41-0.68; P &lt; .001), heart failure (HR = 0.33; 95% CI, 0.18-0.59; P &lt; .001), and cardiovascular mortality (HR = 0.45; 95% CI, 0.26-0.79; P = .005) compared with patients receiving ATDs. Compared with ATDs, RAI was associated with lower MACE risk (HR = 0.45; 95% CI, 0.22-0.93; P = .03). Risks for acute myocardial infarction and stroke did not significantly differ between treatment groups.Conclusions and RelevanceIn this study, surgery was associated with lower long-term risks of MACE and all-cause mortality, while RAI was associated with a lower MACE risk compared with ATDs.

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Section: Discussionsupporting

confidence: 93%

MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy

Peng,

Lin,

Lee

et al. 2024

JAMA Netw Open

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“…In addition, an increase or decrease in the concentration of these hormones affects the cardiovascular system's function [1,6]. Resulting in alterations in the frequency, rhythm, and cardiac output of the heart [1,7].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Complications of Hyperthyroidism

Assefi¹

2023

J Critical Care & Emerg Med

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Thyrotoxicosis is a clinical syndrome caused by an excess of thyroid hormones circulating in the body. Myocardium and blood arteries have thyroid hormone receptors; hence, an increase or decrease in thyroid hormone levels can alter cardiovascular function. Cardiovascular complications are obvious in-patient with hyperthyroidism. Palpitations, tachycardia, exercise intolerance, dyspnea with exertion, expanded pulse pressure, and on occasion atrial fibrillation are associated with hyperthyroidism, excessive endogenous thyroid hormone production, and thyrotoxicosis, the condition caused by excess thyroid hormone. In the early stages of hyperthyroidism, a high cardiac output and hypertrophy of the left ventricle are observed, followed by biventricular dilatation and congestive heart failure. Atrial fibrillation and pulmonary arterial hypertension can contribute to the higher morbidity associated with untreated hyperthyroidism. Therefore, early and effective treatment of hyperthyroidism is required to prevent thyrotoxic cardiomyopathy.

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