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Cardiovascular involvement in patients with different causes of hyperthyroidism

Nature Reviews Endocrinology volume 6, pages 431–443 (2010)Cite this article

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Abstract

Various clinical disorders can cause hyperthyroidism, the effects of which vary according to the patient's age, severity of clinical presentation and association with other comorbidities. Hyperthyroidism is associated with increased morbidity and mortality from cardiovascular disease, although whether the risk of specific cardiovascular complications is related to the etiology of hyperthyroidism is unknown. This article will focus on patients with Graves disease, toxic adenoma and toxic multinodular goiter, and will compare the cardiovascular risks associated with these diseases. Patients with toxic multinodular goiter have a higher cardiovascular risk than do patients with Graves disease, although cardiovascular complications in both groups are differentially influenced by the patient's age and the cause of hyperthyroidism. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism and are prevalent in patients aged ≥60 years with toxic multinodular goiter, particularly in those with underlying cardiac disease. An increased risk of stroke is common in patients >65 years of age with atrial fibrillation. Graves disease is linked with autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Consequently, the etiology of hyperthyroidism must be established to enable correct treatment of the disease and the cardiovascular complications.

Key Points

  • The etiology of hyperthyroidism must be established to enable the correct treatment of hyperthyroidism and its associated cardiovascular complications

  • Patients with Graves disease or toxic multinodular goiter are at increased cardiovascular risk; however, their cardiovascular complications are influenced by their age, comorbidities, and the cause of hyperthyroidism

  • Patients with toxic multinodular goiter have an increased prevalence of atrial fibrillation and atrial enlargement, as well as an increased risk of cerebrovascular disease

  • Graves disease is associated with dilated cardiomyopathy, antiphospholipid syndrome and a high prevalence of pulmonary arterial hypertension

  • Atrial fibrillation is an independent predictor of chronic heart failure in patients with hyperthyroidism

  • Autoimmunity underpins both autoimmune thyroid disease and myxoid degeneration of the mitral valves

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Figure 1
Figure 2: Factors responsible for reduced cardiovascular reserve in hyperthyroid patients.
Figure 3: A comparison of the prevalence of cardiac arrythmias in untreated patients with hyperthyroidism and healthy controls matched for age and sex.
Figure 4: Prevalence of myxomatous valve degeneration in patients with autoimmune Hashimoto thyroiditis, Graves disease, toxic multinodular goiter, and a large control population.
Figure 5: The prevalence of pulmonary arterial hypertension in individuals with various forms of hyperthyroidism and patients with Graves disease in comparison to healthy controls.

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Acknowledgements

We are grateful to Jean Ann Gilder of Scientific Communication Srl for editing the manuscript. These services were funded by the University of Naples Federico II.

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  1. Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy

    Bernadette Biondi

  2. Department of Medicine I, Gutenberg University Medical Center, Langenbeckstrasse 1, Mainz, 55101, Germany

    George J. Kahaly

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  1. Bernadette Biondi
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Correspondence to Bernadette Biondi.

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Biondi, B., Kahaly, G. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol 6, 431–443 (2010). https://doi.org/10.1038/nrendo.2010.105

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