DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161999

Cardiovascular manifestations in hyperthyroidism

Vairamani Kandan, Sathyamurthy P., Rajkumar M., Lavanya Narayanan

Abstract


Background: It is well known that thyroid hormone directly affects the heart and peripheral vascular system. In hyperthyroidism, cardiovascular manifestations are frequent findings. Atrial arrhythmias, limitations in exercise tolerance, and congestive heart failure were reported to occur more common in older patients as a result of hyperthyroidism. Cardiovascular signs of hyperthyroidism include tachycardia, widened pulse pressure, marked increase in cardiac output with impaired cardiovascular and respiratory exercise capacity. Most of the cardiac abnormalities return to normal once a euthyroid state has been achieved in a majority of patients. There are very few studies which address the most important cardiovascular manifestations of hyperthyroidism particularly in Indian population. Hence this study is aimed at addressing this area. The aim was to study the prevalence of various cardiac manifestations in overt and subclinical hyperthyroidism.

Methods: 50 patients of hyperthyroidism who visited general medicine department of Sri Ramachandra Medical College, Chennai, India was included in the study. Patients with other co-morbidities which could contribute to cardiovascular manifestations were excluded from the study. All the patients underwent clinical evaluation, basic laboratory tests like CBC, RFT, LFT, serum electrolytes, fasting lipid profile (which included serum triglycerides, LDL, HDL, total cholesterol), FT4, FT3 and TSH and radiological variables were studied in these patients.           ECG and 2D ECHO were performed in these patients to analyze the presence of any cardiac manifestations in these patients..

Results: In this study females (60%) were more than males (40%), commonest cardio vascular symptoms were palpitation (78%), followed by dyspnoea (26%) and chest pain (4%). The commonest cardio vascular signs were found to be tachycardia (82%), widened pulse pressure (50%) and pedal edema (12%). The commonest ECG finding was found to be Sinus tachycardia (46%) followed by atrial fibrillation (28%), Non-Specific ST-T changes, left ventricular hypertrophy, RV hypertrophy and RBBB. Systolic dysfunction and chamber enlargement (18%) were the commonest echo findings.

Conclusions: This study shows that cardiovascular manifestations are quite common and varied in hyperthyroidism which are to be looked for in the management.

 


Keywords


Hyperthyroidism, Cardiovascular manifestations, Atrial fibrillation

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References


Klein I, Danzi S. Thyroid disease and heart. Circulation. 2007;116:1725-35.

Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Endo Journals Org. 2004;59:31-50.

Klein I. Thyroid Hormone and the cardiovascular system. Am J Med. 1990;88(6):631-7.

Tribulova N, Knezl V, Shainberg A, Seki S, Soukup T. Thyroid hormones and cardiac arrhythmias. Vascul Pharmacol. 2010;52(3):102-12.

Jayaprasad N, Francis J. Atrial Fibrillation and Hyperthyroidism. Indian Pacing Electrophysiol J. 2005;5(4):305-11.

Symons C. Thyroid heart disease. Br Heart J. 1979;41:257-62.

Von OK. Cardiac arrhythmias and heart rate in hyperthyroidism. Am J Cardiol. 1989;63:930-3.

Klein I, Ojamaa K. The cardiovascular system in hyperthyroidism. 8th ed. In: Werner and Ingbar’s The Thyroid: A fundamental and clinical text, Braverman LE, Utiger RD, eds. Philadelphia: Lippincott Williams and Wilkins;2000:777-82.

Osman F. Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. J Am Coll Cardiol. 2007;49(1):71-81.

Zarger. Thyrotoxicosis. Annals of Saudi Medicine. 2000;20(5-6):484-7.

Parmar MS. Thyrotoxic atrial fibrillation. Med Gen Med. 2005;7(1):74.

Bar S, Ehrenfeld M, Eliakim M. Arterial embolism in thyrotoxicosis with atrial fibrillation. Arch Intern Med. 1981;141(9):1191-2.

Mercé J, Ferrás S, Oltra C, Sanz E, Vendrell J, Simón I et al. Cardiovascular abnormalities in hyperthyroidism: a prospective doppler echocardiographic study. Am J Medicine. 2005;118:126-31.

Siu CW, Zhang XH, Yung C, Kung AW, Lau CP, Tse HF. Hemodynamic changes in hyperthyroidism-related pulmonary hypertension: a prospective echocardiographic study. J Clinic Endocrino Metabo. 2007;92(5):1736-42.

Roffi M, Cattano F, Topol JE. Thyrotoxicosis and the cardiovascular system: subtle but serious effects. Cleveland Clinic J Med. 2003;7:57-63.

Yue W. Hyperthyroidism-induced left ventricular diastolic dysfunction: implication in hyperthyroidism-related heart failure. Clinical Endocrinology. 2011;74(5):636-43.

Fadel BM, Ellahham S, Ringel MD, Lindsay J Jr, Wartofsky L, Burman KD. Hyperthyroid heart disease. Clinical Cardiology. 2000;23:402-8.

Poliker R. The thyroid and the heart. Circulation. 1993;87:1435-41.

Boindi B. Effects of subclinical thyroid dysfunction on the heart. Annuals Internal Med. 2002;137:904-14.

Davis FT, Larsen RP. Thyrotoxicosis. In: William’s Text book of endocrinology, Larsen Melmed, Polonsky, 10th ed. Philadelphia: Saunders. 2003;374-422.

Davis FT, Larsen RP. Hypothyroidism and thyroiditis. In: William’s text book of endocrinology, Larsen Melmed, Polonsky. 10th ed. Philadelphia: Saunders. 2003;423-55.

Klein I. Endocrine disorder and cardiovascular diseases. In: Braunwald’s heart disease. 10th ed. Philadelphia: Saunders. 2008;432-49.

Parry CH. Enlargement of the thyroid gland in connection with enlargement or palpitation of the heart. Collections from the unpublished papers of the late Caleb Hillier Parry.1825;111-25.

Graves RJ. Newly observed affections of the thyroid gland in females. London Med Surg J. 1835;7:516-7.

Von BCA. Exophthalmos durch hypertrophie des zellgewebes in der augenho hle. Wschr Ges Heilk. 1840;197-220.

Zondek H, Leszynsky HE. Pathogenesis of hyperthyroidism. Dual role of iodine in thyroid function. Lancet. 1968;1(7544):671-2.

Anatomy of the Human Body. Available at http://www.bartleby.com/ 107/. Accessed on 12 February 2016.

Nussey S, Whitehead S. Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers. 2001.

Paul MY. Physiological and molecular basis of thyroid hormone action. Physiological Reviews. 2001;81(3):1097-126.

Clare BH, Graham RW. The mechanism of thyroid hormone. Thyroid. 2002;12(6):441-6.

Dillmann WH. Cellular Action of Thyroid Hormone on the Heart. Thyroid. 2002;12(6):447-52.

Denzi S, Klien I. Thyroid hormone and blood pressure regulation. Current Hypertension Reports. 2003;5:513-52.

Toft A, Boon N. Thyroid disease and heart. Heart. 2000;84:455-60.

Dahl P. Thyrotoxic cardiac disease. Current Heart Failure Reports. 2008;5:170-8.

Gammage MD, Parle JV, Holder RL, Roberts LM, Hobbs FD, Wilson S, et al. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med. 2007;167:928-34.

Forfar JC, Muir AL, Toft AD. Left ventricular function in hypothyroidism responses to exercise and beta adrenoceptor blockade. Br Heart J. 1982;48:278-84.

Moolman JA. Thyroid hormone and the heart. Cardiovascular J South Africa. 2002;13(3):159-63.

Kahaly JG, Dillmann HW. Thyroid hormone action in the heart. Endocrine Reviews. 2005;26:704-28.

Goland S, Shimoni S, Kracoff O. Dilated cardiomyopathy in thyrotoxicosis. Heart. 1999;81:444-9.

Ansari SM, Haider S, Awal MA, Khanam N, Siddique AB. Cardiac complications of hyperthyroidism: echocardiographic evaluation of 69 hyperthyroid patients. Transactional Analysis Journal. 2004;17(1):6-9.