Risk of Cardiovascular Complications in Thyrotoxicosis: Thyroidectomy Versus Nonoperative Management

Thyrotoxicosis is a hypermetabolic state that can be managed with antithyroid drugs, radioactive iodine (RAI), or thyroidectomy. However, the long-term cardiovascular effects of these treatments remain unclear. This study evaluates surgical versus nonsurgical approaches on new-onset cardiovascular complications in thyrotoxicosis patients.

A retrospective analysis of electronic medical records (2005-2024) using TriNetX data identified patients diagnosed with thyrotoxicosis. Propensity score matching (1:1) balanced surgical and nonsurgical cohorts. Kaplan-Meier analysis was performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular and other outcomes.

The initial cohort included 161,677 thyrotoxicosis patients, of whom 21,450 (12.5%) underwent thyroidectomy, 26,848 (15.7%) received RAI, and 122,838 (71.8%) were treated medically. After matching, thyroidectomy was associated with a lower risk of the primary composite cardiovascular outcome (HR 0.82, 95% CI 0.76-0.87) and all-cause mortality (HR 0.60, 95% CI 0.54-0.66) compared to medical therapy. Thyroidectomy was also associated with lower risks of incident cerebral infarction (HR 0.78, 95% CI 0.68-0.90), atrial fibrillation/flutter (HR 0.57, 95% CI 0.50-0.64), and heart failure (HR 0.71, 95% CI 0.64-0.78). Compared with RAI, thyroidectomy was associated with a lower risk of the composite cardiovascular outcome (HR 0.81, 95% CI 0.75-0.87), although no significant difference in mortality was observed (HR 0.93, 95% CI 0.83-1.03). As expected, thyroidectomy was associated with higher risks of hypoparathyroidism (HR 12.4, 95% CI 9.8-15.6) and vocal cord palsy (HR 11.2, 95% CI 8.49-14.76).

Thyroidectomy, a definitive treatment, is associated with lower cardiovascular risks compared with medical or RAI therapies.