Occult thyrotoxicosis: A correctable cause of “idiopathic” atrial fibrillation

Forfar, J. C.; Miller, Hugh C.; Toft, A. D.

doi:10.1016/0002-9149(79)90243-1

Cited by 145 publications

(51 citation statements)

References 18 publications

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“…Importantly, patients with new onset of atrial fibrillation may have occult subclinical hyperthyroidism and the treatment with antithyroid drugs may reverse the atrial fibrillation in these cases. This supports the hypothesis that subclinical thyrotoxicosis is among the factors that trigger atrial fibrillation (107,108).…”

Section: Cardiovascular Systemsupporting

confidence: 88%

Subclinical hyperthyroidism: clinical features and treatment options

et al. 2005

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Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.European Journal of Endocrinology 152 1-9

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Section: Cardiovascular Systemsupporting

confidence: 88%

Subclinical hyperthyroidism: clinical features and treatment options

et al. 2005

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“…The prevalence of hyperthyroid-AF in the AF ablation candidates was 4.7%, which was not rare and was similar to the estimated prevalence of hyperthyroid-AF despite euthyroid restoration in the general AF population without structural heart disease. 2-4, 12 After euthyroid restoration, hyperthyroidism was unlikely to be of benefit in the patient selection for AF ablation. AF ablation provides a possibility to cure drug-refractory AF in a significant number of patients with Hyperthyroid-AF as well as those with Non-thyroid-AF.…”

Section: Major Findingsmentioning

confidence: 99%

“…13 Biochemical evidence of hyperthyroidism, however, was present in 13% of AF patients without structural heart disease. 12 Furthermore, onethird of AF patients with hyperthyroidism remain in AF despite euthyroid restoration. 2-4 Therefore, the prevalence of Hyperthyroid-AF after euthyroid restoration is estimated to be at least 4.3% (one-third of 13%) of AF patients without structural heart disease.…”

Section: Prevalence Of Hyperthyroidism In the Af Ablation Candidatesmentioning

confidence: 99%

Prevalence and Influence of Hyperthyroidism on the Long-Term Outcome of Catheter Ablation for Drug-Refractory Atrial Fibrillation

Machino

Tada

Sekiguchi

et al. 2012

Circ J

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“…Typical cardiovascular symptoms found at presentation of thyrotoxicosis include palpitation, tachycardia, exercise intolerance, exertional dyspnoea and orthopnoea (Klein & Ojamaa 2001). While these are present in the majority of subjects with overt thyroid hormone excess, their clinical importance is overshadowed by the challenges posed by atrial fibrillation (AF), which occurs in 5-15% of patients with thyrotoxicosis and may be the presenting problem (Sandler & Wilson 1959, Forfar et al 1979, Sawin et al 1994, Gilligan et al 1996. Higher prevalence rates are found in older patients and in those with known or suspected underlying organic heart disease (Forfar et al 1979, Nordyke et al 1988.…”

Section: Thyroid Hormone and The Heartmentioning

confidence: 99%

“…While these are present in the majority of subjects with overt thyroid hormone excess, their clinical importance is overshadowed by the challenges posed by atrial fibrillation (AF), which occurs in 5-15% of patients with thyrotoxicosis and may be the presenting problem (Sandler & Wilson 1959, Forfar et al 1979, Sawin et al 1994, Gilligan et al 1996. Higher prevalence rates are found in older patients and in those with known or suspected underlying organic heart disease (Forfar et al 1979, Nordyke et al 1988. Despite this clear association between thyrotoxicosis and AF, when subjects with new onset of AF have been investigated, overt hyperthyroidism has been reported to be an uncommon cause (<1%) (Krahn et al 1996), so although hyperthyroidism is a risk factor for AF, this association is uncommon in the absence of additional symptoms and signs of thyrotoxicosis.…”

Section: Thyroid Hormone and The Heartmentioning

confidence: 99%

Thyroid hormone in health and disease

Boelaert

Franklyn²

2005

Journal of Endocrinology

225

127

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Thyroid disease is common, affecting around 2% of women and 0·2% of men in the UK. Our understanding of the effects of thyroid hormones under physiological circumstances, as well as in pathological conditions, has increased dramatically during the last two centuries and it has become clear that overt thyroid dysfunction is associated with significant morbidity and mortality. Both hypoand hyperthyroidism and their treatments have been linked with increased risk from cardiovascular disease and the adverse effects of thyrotoxicosis in terms of osteoporosis risk are well established. Although the evidence suggests that successful treatment of overt thyroid dysfunction significantly improves overall survival, the issue of treating mild or subclinical hyper-and hypothyroidism remains controversial. Furthermore, the now wellestablished effects of thyroid hormones on neurodevelopment have sparked a whole new debate regarding the need to screen pregnant women for thyroid function abnormalities. This review describes the current evidence of the effects of thyroid hormone on the cardiovascular, skeletal and neurological systems, as well as the influence of thyroid diseases and their treatments on the development of malignancy. Furthermore we will describe some recent developments in our understanding of the relationship between thyroid status and health.

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Occult thyrotoxicosis: A correctable cause of “idiopathic” atrial fibrillation

Cited by 145 publications

References 18 publications

Subclinical hyperthyroidism: clinical features and treatment options

Subclinical hyperthyroidism: clinical features and treatment options

Prevalence and Influence of Hyperthyroidism on the Long-Term Outcome of Catheter Ablation for Drug-Refractory Atrial Fibrillation

Thyroid hormone in health and disease

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