Thyroid dysfunction on the heart: clinical effects, prognostic impact and management strategies

Mattesi, Giulia; Michele, Sara Di; Mele, Donato; Rigato, Ilaria; Bariani, Riccardo; Fiorencis, Andrea; Previtero, Marco; Sergani, Abdullah Al; Leoni, Loira; Bauce, Barbara; Pergola, Valeria

doi:10.4081/monaldi.2022.2145

Cited by 2 publications

(6 citation statements)

References 40 publications

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“…Clinical manifestations of thyrotoxicosis include anxiety, insomnia, palpitations, weight loss from increased metabolism and energy expenditure, diarrhea or loose stools, excessive sweating, heat intolerance, and irregular menses . Approximately 2% of older people with hyperthyroidism present with apathetic hyperthyroidism with minimal symptoms .…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Untreated overt thyrotoxicosis, especially in older individuals, may cause osteoporosis, atrial fibrillation, and, rarely, high-output heart failure from the effect of excess thyroid hormone on the thyroid hormone receptors present in the bone and heart. Atrial fibrillation is present in 10% to 25% of patients with thyrotoxicosis, with higher risks in men and those older than 65 years . Treatment should be patient centered and individualized, taking into account age, comorbidities, severity of hyperthyroidism, likelihood of remission, plans for pregnancy, available surgical expertise, and patient preferences (Table 3).…”

Section: Methodsmentioning

confidence: 99%

“…Thyroid scintigraphy using radioactive iodine or technetium Tc 99m pertechnetate is recommended if palpable thyroid nodules are present or if the thyrotoxicosis etiology is unclear after TRAb testing. Thyroid scintigraphy assesses activity of the thyroid gland by 15 from the effect of excess thyroid hormone on the thyroid hormone receptors present in the bone and heart. Atrial fibrillation is present in 10% to 25% of patients with thyrotoxicosis, with higher risks in men and those older than 65 years.…”

Section: Imaging Studiesmentioning

confidence: 99%

“…Atrial fibrillation is present in 10% to 25% of patients with thyrotoxicosis, with higher risks in men and those older than 65 years. 15 Treatment should be patient centered and individualized, taking into account age, comorbidities, severity of hyperthyroidism, likelihood of remission, plans for pregnancy, available surgical expertise, and patient preferences (Table 3). [30][31][32][33][34][35][36][37][38][39][40][41] Treatment choices should be informed by the underlying etiology.…”

Section: Imaging Studiesmentioning

confidence: 99%

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Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Imaging Studiesmentioning

confidence: 99%

Section: Imaging Studiesmentioning

confidence: 99%

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Hyperthyroidism

Lee,

Pearce

2023

JAMA

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Increased thyroid stimulating hormone (TSH) as a possible risk factor for atherosclerosis in subclinical hypothyroidism

Alomair,

Al-Kuraishy,

Al-Gareeb

et al. 2024

Thyroid Res

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Primary hypothyroidism (PHT) is associated with an increased risk for the development of atherosclerosis (AS) and other cardiovascular disorders. PHT induces atherosclerosis (AS) through the induction of endothelial dysfunction, and insulin resistance (IR). PHT promotes vasoconstriction and the development of hypertension. However, patients with subclinical PHT with normal thyroid hormones (THs) are also at risk for cardiovascular complications. In subclinical PHT, increasing thyroid stimulating hormone (TSH) levels could be one of the causative factors intricate in the progression of cardiovascular complications including AS. Nevertheless, the mechanistic role of PHT in AS has not been fully clarified in relation to increased TSH. Therefore, in this review, we discuss the association between increased TSH and AS, and how increased TSH may be involved in the pathogenesis of AS. In addition, we also discuss how L-thyroxine treatment affects the development of AS.

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Thyroid dysfunction on the heart: clinical effects, prognostic impact and management strategies

Cited by 2 publications

References 40 publications

Hyperthyroidism

Hyperthyroidism

Increased thyroid stimulating hormone (TSH) as a possible risk factor for atherosclerosis in subclinical hypothyroidism

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