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

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Public Health

Background:

• Hyperthyroidism, characterized by excessive thyroid hormones, elevates cardiovascular risks.
• Comparative long-term outcome data for antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery in newly diagnosed hyperthyroidism are limited.
• Understanding treatment-specific risks is crucial for managing hyperthyroidism and its cardiovascular complications.

Purpose of the Study:

• To compare the long-term risks of major adverse cardiovascular events (MACE) and all-cause mortality.
• To evaluate the comparative effectiveness of ATDs, RAI, and surgery for treating newly diagnosed hyperthyroidism.
• To inform clinical decision-making regarding hyperthyroidism management strategies.

Main Methods:

• Nationwide cohort study utilizing the Taiwan National Health Insurance Research Database.
• Inclusion of patients aged 20+ with newly diagnosed hyperthyroidism (2011-2020).
• Treatment groups (ATDs, RAI, surgery) defined within 18 months; follow-up until MACE, death, or study end.

Main Results:

• Surgery group showed significantly lower risks of MACE (HR=0.76), all-cause mortality (HR=0.53), heart failure (HR=0.33), and cardiovascular mortality (HR=0.45) versus ATDs.
• RAI group demonstrated a lower MACE risk (HR=0.45) compared to the ATD group.
• No significant differences in acute myocardial infarction or stroke risks were observed between treatment groups.

Conclusions:

• Surgery is associated with reduced long-term risks of MACE and all-cause mortality in hyperthyroidism patients.
• Radioactive iodine (RAI) treatment is linked to a lower MACE risk compared to antithyroid drugs (ATDs).
• These findings support considering surgery or RAI for improved long-term cardiovascular outcomes in hyperthyroidism management.