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Thyroid dysfunction and risk of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a

Weijie Zhang1, Fushi Piao2, Wei Fu3

  • 1Department of Emergency, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China.

Frontiers in Endocrinology
|May 4, 2026
PubMed

Insights

Thyroid dysfunction, including subclinical and overt hypothyroidism, increases the risk of atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Thyroid optimization may be key for AF risk stratification in HOCM patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Internal Medicine

Background:

  • Atrial fibrillation (AF) is a significant arrhythmia in hypertrophic obstructive cardiomyopathy (HOCM).
  • The link between thyroid dysfunction and AF in HOCM patients is not well-established.
  • Thyroid hormones critically influence cardiac electrophysiology and atrial remodeling.

Purpose of the Study:

  • To investigate the association between thyroid-stimulating hormone (TSH) levels and incident AF in patients with HOCM.
  • To determine if thyroid dysfunction impacts AF risk in this specific patient population.
  • To explore the potential role of thyroid function in AF risk stratification for HOCM patients.

Main Methods:

  • Retrospective analysis of 755 HOCM patients across three tertiary centers (2019-2024).
  • Patients categorized by TSH levels: <0.55, 0.55-2.49 (reference), 2.50-9.99, and ≥10.00 mIU/L.
  • Multivariable logistic regression and Cox proportional hazards regression analyses were employed.

Main Results:

  • Elevated TSH levels (2.50-9.99 and ≥10.00 mIU/L) were independently associated with a higher risk of incident AF.
  • Odds Ratios (OR) for AF increased with TSH levels (e.g., OR 4.306 for TSH ≥10.00 mIU/L).
  • Restricted cubic spline analysis revealed a U-shaped association between TSH and AF risk.

Conclusions:

  • Both subclinical and overt hypothyroidism are linked to increased incident AF risk in HOCM patients.
  • Thyroid function status is a potential factor for AF risk stratification in HOCM.
  • Further prospective studies are needed to confirm if thyroid optimization can mitigate AF risk in HOCM.
Abstract

Keywords:
atrial fibrillationhypertrophic obstructive cardiomyopathyrisk factorsthyroid dysfunctionthyroid-stimulating hormone

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