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

Purpose Graves' disease (GD) is linked to cardiovascular complications, but reliable non-invasive predictors are limited. This study aimed to assess whether the frontal QRS-T (fQRS-T) angle could predict mortality and cardiovascular outcomes in GD patients. Methods Initially, we conducted a retrospective analysis of electrocardiogram (ECG) parameters from 291 GD patients compared with 96 healthy controls. GD patients were then categorized based on the presence of hyperthyroid heart disease. Using logistic regression, we identified predictors of cardiovascular outcomes. Subsequently, a retrospective cohort study followed 41 patients with an fQRS-T angle ≥90° and 82 matched controls over five years, assessing all-cause mortality and ventricular fibrillation (VF) using Kaplan-Meier analysis. Results Initial analysis showed that a significantly higher proportion of GD patients had an fQRS-T angle ≥90° compared to healthy controls (p< 0.001). Among GD patients, those with hyperthyroid heart disease were more likely to have an fQRS-T angle ≥90° (p < 0.001). Multivariate logistic regression analysis revealed that age, fQRS-T angle, thyroxine (T4), and platelet were independent predictors of hyperthyroid heart disease. In the cohort study, 41 GD patients with an fQRS-T angle ≥90° were selected as the exposure group, and 82 patients without a widened angle were selected as controls. Kaplan-Meier analysis demonstrated a significant difference in event-free survival between the groups, as assessed by log-rank test(P=0.001). Conclusion An increased fQRS-T angle is significantly associated with higher mortality and cardiovascular risk in GD patients. Measuring the fQRS-T angle could enhance risk stratification and guide clinical management in this population

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Radioactive Iodine-131 Therapy Reduced the Risk of MACEs and All-Cause Mortality in Elderly with Hyperthyroidism Combined with Type 2 Diabetes

Guo,

Huang,

Sun

et al. 2024

IJGM

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Aim This study aimed to assess the efficacy of antithyroid drugs (ATDs) and radioactive iodine-131 (RAI) therapies in reducing the risk of major adverse cardiovascular events (MACEs) and all-cause mortality in patients with hyperthyroidism complicated with type 2 diabetes mellitus (T2DM). Methods Between January 2013 and December 2021, 540 subjects were included in the analysis. All participants were followed up for 9 years, with a median of 54 months (2451 person-years). The subjects were categorized into two groups: the ATDs group (n = 414) and the RAI group (n = 126). According to the free triiodothyronine (FT3) tertiles, the patients receiving RAI were further grouped as follows: low-level (≤ 4.70 pmol/L, n = 42), moderate-level (4.70–12.98 pmol/L, n = 42), and high-level (≥ 12.98 pmol/L, n = 42). The efficacy of ATDs and RAI therapies in reducing the risk of MACEs and all-cause mortality was assessed. Results Of the 540 participants, 163 experienced MACEs (30.19%), 25 (15.34%) of whom died. Multivariate Cox regression analyses revealed that RAI was associated with a 38.5% lower risk of MACEs (P = 0.016) and a 77.1% lower risk of all-cause mortality (P = 0.046). Stratified analyses indicated that RAI had a protective effect on MACEs in patients aged ≥ 60 years (P = 0.001, P for interaction = 0.031) and patients with a duration of diabetes mellitus ≥ 6 years (P = 0.013, P for interaction = 0.002). Kaplan‒Meier analysis revealed a lower cumulative incidence of MACEs and all-cause mortality in the RAI group (log-rank, all P < 0.05). Moreover, the ROC curve suggested an optimal FT3 cut-off value of 5.4 pmol/mL for MACE (P < 0.001). Conclusion Our findings suggested that RAI therapy effectively reduced the risk of MACEs and all-cause mortality in elderly patients with hyperthyroidism combined with T2DM.

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

Cited by 4 publications

References 52 publications

Surgery and RAI for Cardiovascular Event Reduction in Hyperthyroidism

Surgery and RAI for Cardiovascular Event Reduction in Hyperthyroidism

Elevated Frontal QRS-T Angle as a Predictor of Cardiovascular Risk in Graves’ Disease: A Comparative Study

Radioactive Iodine-131 Therapy Reduced the Risk of MACEs and All-Cause Mortality in Elderly with Hyperthyroidism Combined with Type 2 Diabetes

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