Published: 2019-09-25

Clinical profile of thyrotoxicosis and related cardiovascular morbidities among patients attending endocrine outpatient department in a tertiary care centre

Harshwardhan V. Khandait, Sunil G. Ambulkar, Parimal S. Tayde


Background: Thyroid disorders are common in India. Symptoms and signs of thyrotoxicosis are nonspecific. Graves disease is an autoimmune condition and is the most common cause of thyrotoxicosis. Cardiovascular system is frequently affected in thyroid disorders but there is not much data on prevalence of thyrotoxicosis and related cardiovascular morbidities in central India. Objectives of study the clinical profile of patients with thyrotoxicosis and outline the related cardiovascular manifestations in a tertiary care center. Design-over a period of nine months a descriptive cross sectional study was conducted in a tertiary health care center.

Methods: A total of 150 patients with thyrotoxicosis were studied. Patients with known diagnosis of thyrotoxicosis and newly diagnosed cases were included. The participants were investigated for thyroid profile, Electrocardiogram, Complete blood count, serum electrolytes and kidney function test.

Results: Out of 150 patients of thyrotoxicosis, 87 (58 %) were diagnosed with Graves’s disease. Hypertension was observed in 78 (52 %) of participants. Atrial fibrillation was found in 18 (12%) and sinus tachycardia in 53 (35.33 %) of the participants.

Conclusion: Grave’s disease is the commonest cause of thyrotoxicosis. Hypertension, sinus tachycardia and Atrial Fibrillation are the common cardiovascular diseases observed to be associated with thyrotoxicosis.


Atrial fibrillation, Cardiovascular system, Graves’ disease, Thyrotoxicosis

Full Text:



Kochupillai N. Clinical Endocrinology in India. Curr Sci. 2000;79(8):1061-7.

Cooper D. Hyperthyroidism. Lancet. 2003;362(9382):459-68.

Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39-51.

Abraham-Nordling M, Bystrom K, Torring O, Lantz M, Berg G, Calissendorff J, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899-905.

Unnikrishnan A, Menon U. Thyroid Disorders in India: An Epidemiological Perspective. Indian J Endocrinol Metab. 2011;15(2):78-81.

Lee JE, Lee DH, Oh TJ, Kim KM, Choi SH, Lim S, et al. Clinical Feasibility of Monitoring Resting Heart rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study. JMIR M Health U Health. 2018;6(7):e159.

Akbar DH, Mushtaq MM, Al-Sheik AA. Etiology and outcome of thyrotoxicosis at a university hospital. Saudi Med J. 2000;21(4):352-4.

Devereaux D, Tewelde SZ. Hyperthyroidism and thyrotoxicosis. Emerg Med Clin North Am. 2014 May;32(2):277-92.

Rotman-Pikielny P, Borodin O, Zissin R, Ness-Abramof R, Levy Y. Newly diagnosed thyrotoxicosis in hospitalized patients: Clinical Characteristics. QJM.2008;101(11):871-4.

Shetty N, Acharya V, Khan MF. Cardiovascular manifestations in patients with thyrotoxicosis based on aetiology. J. Evid. Based Med. Healthc. 2018; 5(16):1399-1402.

Anakwue RC, Onwubere BJ, Ikeh V, Anisiuba B, Ike S, Anakwue AM. Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease. Ther Clin Risk Manag. 2015;11:189-200.

Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014;94(2):355-82.

Biondi B, Palmieri EA, Fazio S, cosco C, Nocera M, Sacca L, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle –aged patients. J Clin Endo crinol Metab. 2000;85(12):4701-5.

Osman F, Gammage MD, Franklyn JA. Hyperthyroidism and cardiovascular morbidity and mortality. Thyroid. 2002;12(6):483-7.

LiVolsi VA, Baloch ZW. The Pathology of Hyperthyroidism. Front Endocrinol (Lausanne). 2018;9:737.

Sharma M, Aronow WS, Patel L, Gandhi K, Desai H. Hyperthyroidism. Med Sci Monit. 2011 Apr;17(4):85-91.

Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646.

Gilbert J. Thyrotoxicosis - investigation and management. Clin Med (Lond). 2017;17(3):274-7.

Hussain Y, Hookam J, Allahabadia A, Balasubramanian S. Epidemiology, Management and outcomes of Grave’s disease- real life data. Endocrine. 2017;56(3):568-78.

Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev.2005;26(5):704-28.

Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.

Tsymbaliuk l, Unukovych D, Shvets N, Dinets A. Cardiovascular complications secondary to Graves’ disease: a prospective study from Ukraine. PLoS One. 2015;10(3):e0122388.

Banzal D, Singhai A, Bakhtar N. Evaluation of cardiovascular status in thyroid disorders. JMSCR 2017;5(5):22387-92.

Hashmi SFA, Dasti MA, Baloch ZAQ. Cardiac manifestations in patients with hyperthyroidism. Indo Am J P Sci. 2017;4(3):507-10.

Zargar AH, Bashir MI, Wani AI, Laway BA, Masoodi SR, Ganie MA, et al. Clinical and endocrine aspects of thyrotoxicosis and its cardiovascular complications. Annals of Saudi Medicine 2000;20(5-6):485-7.

Dhadke SV, Dhadke NV, Korade MB. Clinical profile of thyroid disorders. International Journal of Current Research. 2014;6(9):8484-8.

Baladi IH, Rai AA, Ahmed SM. ECG changes in patients with primary hyperthyroidism. Pan Afr Med J. 2018;30(1):246.

Prisant LM, Gujral JS, Mulloy AL. Hyperthyroidism: a secondary cause of isolated systolic hypertension. J Clin Hypertension. 2006 Aug;8(8):596-9.