Role of Subclinical Iatrogenic Hyperthyroidism in the Setting of Heart Disease and Arrhythmic Burden

Author(s): Sandra Mastroianno, Giuseppe Di Stolfo*, Angela Maggio, Michele Pacilli, Domenico Rosario Potenza, Raimondo Massaro, Giovanni De Luca, Aldo Russo

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 6 , 2020

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Graphical Abstract:


Abstract:

Background: Subclinical hyperthyroidism is defined by a subnormal serum thyroidstimulating hormone (TSH) level with normal free thyroxine (FT4) and free triiodothyronine (FT3) levels. Its prevalence varies from 0.6% to 16% in the elderly and can increase to 20% in patients receiving thyroid hormone replacement therapy. Thyroid disease and/or replacement therapy are frequently associated with cardiovascular involvement.

Cases Presentation: We report three clinical cases of patients with initial subclinical hyperthyroidism and cardiological manifestations, including supraventricular and ventricular extrasystoles, prolapse of the mitral valve with severe regurgitation, higher mean heart rate and deterioration of the arrhythmias on arrhythmogenic dysplasia substrate.

Conclusion: We discuss the role of appropriate and early correction of thyroid dysfunction in improving cardiological manifestations.

Keywords: Subclinical hyperthyroidism, heart disease, arrhythmia, mitral valve insufficiency, accessory pathway, l-thyroxine.

[1]
Osuna, P.M.; Udovcic, M.; Sharma, M.D. Hyperthyroidism and the Heart. Methodist DeBakey Cardiovasc. J., 2017, 13(2), 60-63.
[http://dx.doi.org/10.14797/mdcj-13-2-60] [PMID: 28740583]
[2]
Donangelo, I.; Suh, S.Y. Subclinical Hyperthyroidism: When to Consider Treatment. Am. Fam. Physician, 2017, 95(11), 710-716.
[PMID: 28671443]
[3]
Grossman, A.; Weiss, A.; Koren-Morag, N.; Shimon, I.; Beloosesky, Y.; Meyerovitch, J. Subclinical Thyroid Disease and Mortality in the Elderly: A Retrospective Cohort Study. Am. J. Med., 2016, 129(4), 423-430.
[http://dx.doi.org/10.1016/j.amjmed.2015.11.027] [PMID: 26714213]
[4]
Marks, A.D.; Channick, B.J.; Adlin, E.V.; Kessler, R.K.; Braitman, L.E.; Denenberg, B.S. Chronic thyroiditis and mitral valve prolapse. Ann. Intern. Med., 1985, 102(4), 479-483.
[http://dx.doi.org/10.7326/0003-4819-102-4-479] [PMID: 3838424]
[5]
Dhital, R.; Vyas, S.; Sharma, P.; Lynn, T.; Oladiran, O.; Basnet, S. Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver. Case Rep. Cardiol., 2018, 20183861340
[http://dx.doi.org/10.1155/2018/3861340] [PMID: 30627446]
[6]
Liu, Y-P.; Tsai, W-Y.; Wang, J-K.; Wu, M-H. Reversible mitral valve prolapse and mitral regurgitation in children with Graves’ disease. J. Pediatr. Endocrinol. Metab., 2004, 17(9), 1211-1213.
[http://dx.doi.org/10.1515/JPEM.2004.17.9.1211] [PMID: 15506680]
[7]
Karashima, S.; Tsuda, T.; Kometani, M.; Oka, R.; Demura, M.; Kawashiri, M-A.; Takeda, Y.; Hayashi, K.; Yoneda, T. Severe Mitral Regurgitation As a Result of Rupture of Mitral Valve Chordae Tendineae in a Patient With Graves Disease. J. Endocr. Soc., 2018, 2(11), 1246-1250.
[http://dx.doi.org/10.1210/js.2018-00173] [PMID: 30402588]
[8]
Mulatu, H.A. Pattern and Presentation of Thyro-Cardiac Disease among Patients with Hyperthyroidism Attending a Tertiary Hospital in Ethiopia: A Cross Sectional Study. Ethiop. J. Health Sci., 2019, 29(1), 887-894.
[PMID: 30700956]
[9]
Pierre, K.; Gadde, S.; Omar, B.; Awan, G.M.; Malozzi, C. Thyrotoxic Valvulopathy: Case Report and Review of the Literature. Cardiol. Res., 2017, 8(3), 134-138.
[http://dx.doi.org/10.14740/cr564w] [PMID: 28725332]
[10]
Vassallo, P.; Trohman, R.G. Prescribing amiodarone: an evidence-based review of clinical indications. JAMA, 2007, 298(11), 1312-1322.
[http://dx.doi.org/10.1001/jama.298.11.1312] [PMID: 17878423]
[11]
Kinoshita, S.; Hayashi, T.; Wada, K.; Yamato, M.; Kuwahara, T.; Anzai, T.; Fujimoto, M.; Hosomi, K.; Takada, M. Risk factors for amiodarone-induced thyroid dysfunction in Japan. J. Arrhythm., 2016, 32(6), 474-480.
[http://dx.doi.org/10.1016/j.joa.2016.03.008] [PMID: 27920832]
[12]
Bartalena, L.; Bogazzi, F.; Chiovato, L.; Hubalewska-Dydejczyk, A.; Links, T.P.; Vanderpump, M. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction. Eur. Thyroid J., 2018, 7(2), 55-66.
[http://dx.doi.org/10.1159/000486957] [PMID: 29594056]
[13]
Ross, D.S.; Burch, H.B.; Cooper, D.S.; Greenlee, M.C.; Laurberg, P.; Maia, A.L.; Rivkees, S.A.; Samuels, M.; Sosa, J.A.; Stan, M.N.; Walter, M.A. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 2016, 26(10), 1343-1421.
[http://dx.doi.org/10.1089/thy.2016.0229] [PMID: 27521067]
[14]
Floriani, C.; Gencer, B.; Collet, T-H.; Rodondi, N. Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update. Eur. Heart J., 2018, 39(7), 503-507.
[http://dx.doi.org/10.1093/eurheartj/ehx050] [PMID: 28329380]
[15]
Naqvi, S.Y.; Luebbert, J.J.; Rosen, S.G. Thyroid storm in a patient with Wolff-Parkinson-White syndrome. BMJ Case Rep.,, 2015, 2015. 2015
[http://dx.doi.org/10.1136/bcr-2015-212569] [PMID: 26670895]
[16]
Udovcic, M.; Pena, R.H.; Patham, B.; Tabatabai, L.; Kansara, A. Hypothyroidism and the Heart. Methodist DeBakey Cardiovasc. J., 2017, 13(2), 55-59.
[http://dx.doi.org/10.14797/mdcj-13-2-55] [PMID: 28740582]
[17]
Estrada, J.M.; Soldin, D.; Buckey, T.M.; Burman, K.D.; Soldin, O.P. Thyrotropin isoforms: implications for thyrotropin analysis and clinical practice. Thyroid, 2014, 24(3), 411-423.
[http://dx.doi.org/10.1089/thy.2013.0119] [PMID: 24073798]


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Article Details

VOLUME: 20
ISSUE: 6
Year: 2020
Page: [959 - 962]
Pages: 4
DOI: 10.2174/1871530320666191227103627
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