Electrocardiographic voltage changes during hyperthyroidism

Electrocardiograms of 67 thyrotoxic patients were studied. Subsequent electrocardiograms during euthyroidism in 16 patients permitted an analysis of voltage changes. Decreases in voltages after radioiodine therapy were significant (P less than 0.01) for the P wave in lead, V1, R wave in leads II, AVF, V4, V5, and V6, maximal RS wave, and maximal R wave and were present in all but one patient. Criteria for left ventricular hypertrophy (sum of S wave in V1 plus R wave in V5 or V6 greater than 35 mm), present in 21% of patients, regressed in all five patients who had later electrocardiograms during euthyroidism. Left ventricular hypertrophy or high-voltage R waves in the absence of usual causes may suggest the presence of hyperthyroidism. The concept that cardiac voltage is determined in part by thyroid hormone is reviewed; this relationship may be the basis for increased voltage in hyperthyroidism as well as decreased voltage in hypothyroidism.