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Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a
Essi Ryödi1, Jorma Salmi, Pia Jaatinen
1Heart Center Co., Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
Insights
Hyperthyroidism increases cardiovascular disease hospitalization risk for up to 20 years post-thyroidectomy, but does not raise mortality. This long-term study highlights sustained cardiovascular risks in treated hyperthyroid patients.
Area of Science:
- Endocrinology
- Cardiology
- Public Health
Background:
- Hyperthyroidism is linked to increased cardiovascular morbidity, even after achieving euthyroidism.
- Mechanisms and treatment-specific risks for cardiovascular complications in hyperthyroidism require further elucidation.
- Long-term cardiovascular outcomes following surgical treatment for hyperthyroidism are not fully understood.
Purpose of the Study:
- To compare cardiovascular hospitalization rates and mortality in surgically treated hyperthyroid patients versus a matched reference population.
- To investigate the long-term cardiovascular risk trajectory following thyroidectomy for hyperthyroidism.
Main Methods:
- A population-based cohort study involving 4334 hyperthyroid patients treated with thyroidectomy (1986-2007) and 12,991 controls.
- Analysis of cardiovascular disease (CVD) hospitalizations prior to thyroidectomy.
- Cox regression analysis to determine hazard ratios for post-thyroidectomy CVD hospitalizations, adjusted for prevalent CVD.
Main Results:
- Cardiovascular disease hospitalization risk was 50% higher in hyperthyroid patients 5 years before thyroidectomy (P < 0.001).
- Post-thyroidectomy, hospitalizations for all CVDs (HR 1.15), hypertension (HR 1.23), heart failure (HR 1.17), and valvular diseases/cardiomyopathies (HR 1.55) remained elevated for two decades.
- No significant difference in cardiovascular mortality was observed between hyperthyroid patients and controls.
Conclusions:
- Hyperthyroidism significantly elevates the risk of cardiovascular disease hospitalization, a risk that persists for up to 20 years after thyroidectomy.
- Effective surgical treatment for hyperthyroidism does not eliminate the long-term increased risk of cardiovascular hospitalizations.
- Despite increased cardiovascular morbidity, excess cardiovascular mortality was not found in this middle-aged cohort.
Objective:
Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population.
Patients And Measurements:
A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy.
Results:
The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality.
Conclusions:
The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied.
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