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Hyperthyroidism and cardiovascular morbidity and mortality
Faizel Osman1, Michael D Gammage, Jayne A Franklyn
1Department of Cardiovascular Medicine, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, England.
Insights
Even treated hyperthyroidism may lead to long-term cardiovascular risks. Studies show increased mortality from heart and brain diseases, even with subclinical hyperthyroidism, highlighting the need for ongoing monitoring.
Area of Science:
- Endocrinology
- Cardiology
- Public Health
Background:
- Hyperthyroidism, an overactive thyroid, impacts multiple body systems, notably the cardiovascular system.
- Effective treatments foster a belief in hyperthyroidism's complete reversibility, overlooking potential long-term adverse outcomes.
- Emerging evidence indicates persistent health risks even after hyperthyroidism treatment.
Purpose of the Study:
- To investigate the long-term cardiovascular and cerebrovascular consequences of treated hyperthyroidism.
- To assess the mortality risks associated with both overt and subclinical hyperthyroidism.
- To explore the role of thyroid hormone effects on cardiac and vascular systems.
Main Methods:
- Long-term follow-up studies were conducted on patients with a history of hyperthyroidism.
- Analysis included mortality data from cardiovascular and cerebrovascular events.
- The study considered patients treated with radioiodine and those with subclinical hyperthyroidism.
Main Results:
- Increased mortality from cardiovascular and cerebrovascular diseases was observed in individuals with a history of overt hyperthyroidism treated with radioiodine.
- Subclinical hyperthyroidism was also associated with elevated mortality risks.
- Thyroid hormones directly affect the myocardium and vasculature, predisposing to arrhythmias like atrial fibrillation.
Conclusions:
- Hyperthyroidism, even when treated, may not be entirely reversible and can lead to lasting cardiovascular and cerebrovascular damage.
- Atrial fibrillation, a known complication of hyperthyroidism, contributes to increased mortality through embolic phenomena.
- Long-term monitoring is crucial for patients with a history of hyperthyroidism, including subclinical cases, to mitigate associated health risks.
Abstract:
Hyperthyroidism is a common disorder affecting multiple systems in the body. The cardiovascular effects are among the most striking. The availability of effective treatments for hyperthyroidism has led to the widespread perception that it is a reversible disorder without any long-term consequences. Recent evidence suggests, however, that there may be adverse outcomes. Long-term follow-up studies have revealed increased mortality from cardiovascular and cerebrovascular disease in those with a past history of overt hyperthyroidism treated with radioiodine, as well as those with subclinical hyperthyroidism. Thyroid hormones are known to exert direct effects on the myocardium, as well as the systemic vasculature and predispose to dysrhythmias, especially supraventricular. Atrial fibrillation (AF) is a recognized complication of overt hyperthyroidism, and subclinical hyperthyroidism is also known to be a risk factor for development of AF. Supraventricular dysrhythmias, particularly atrial fibrillation, in older patients may account for some of the excess cardiovascular and cerebrovascular mortality described, especially because AF is known to predispose to embolic phenomena.