CARDIAC MANIFESTATIONS IN THYROTOXICOSIS: A CROSS-SECTIONAL STUDY.

Main Article Content

Bashir Ahmed Khuhro
Jagdesh Kumar
Ashok Kumar Lohano
Muhammad Khan Soomro
Anwar Ali Jamali
Irfan Ali Arbab

Keywords

Thyrotoxicosis Cardiac Manifestations

Abstract

Objective: To determine the frequency of cardiovascular (CVS) symptoms in patients presenting with thyrotoxicosis.


Design: cross sectional study


Place & duration of study: Medical and Cardiology department of Peoples University of Medical & Health Sciences for Women (PUMHSW) Hospital Nawabshah from June 2022 to May 2023.


Methodology: Adult male and female patient with age of 18 years and above presented to the outpatient/inpatient of medical/cardiology department with specific signs and symptoms with elevated serum T3 level, serum T4 level or low serum TSH level were enrolled. All data including signs and symptoms of hyperthyroidism, and results of biochemical, electrocardiographic, and echocardiographic findings of all patients were collected through questionnaire.


Results: total 150 patients were enrolled. Among them, 80.2% of subjects were female, while 19.8% were male with mean age 41.19±11.078%. The palpitations were the most common manifestation (69.00%). During cardiac examination, tachycardia was noted in 82.6% of the subjects, hypertension in 42.2%, and elevated pulse pressure in 32.8%. The mean pulse rate was 121.3103 ±105.98568beats per minute and mean pulse pressure was 53.3±8103 mm Hg. On cardiac auscultation the loud S1 was found in in 76.7% of patients and a systolic ejection murmur at pulmonary area in 25.9% of subjects (Table 2).


Conclusion. In patients with thyrotoxicosis palpitation, chest pain, breathlessness were the dominant cardiac manifestations. So,all patients with thyrotoxicosis presenting with these manifestations should be screened for cardiovascular problems.

Abstract 58 | PDF Downloads 57

References

1. Heuck, Claus C, Kallner, Anders, Kanagasabapathy, A. World Health Organization. Diagnostic Imaging and Laboratory Technology. (‎2000)‎. Diagnosis and monitoring of diseases of the thyroid / by C. C Heuck.[‎et al.]‎. World Health Organization. https://apps.who.int/iris/handle/10665/66342 (Accessed on 4/07/2022)
2. Canaris GJ, Monowity NR, Mayor G, Ridgway EC. The Colorado thyroid prevalence study. Arch Intern Med. 2000;160:526–534. doi:10.1001/archinte.160.4.526.
3. Blick C, Nguyen M, Jialal I. Thyrotoxicosis. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482216/(Accessed on 4/03/2023)
4. Gilbert J. Thyrotoxicosis - investigation and management . Clin Med (Lond). 2017 Jun;17(3):274-277. doi: 10.7861/clinmedicine.17-3-274.
5. Welsh KJ, Soldin SJ. DIAGNOSIS OF ENDOCRINE DISEASE: How reliable are free thyroid and total T3 hormone assays? Eur J Endocrinol. 2016 Dec;175(6):R255-R263. doi: 10.1530/EJE-16-0193.
6. Danzi, S., Klein, I. Thyroid hormone and blood pressure regulation. Current Science Inc 5, 513–520 (2003). https://doi.org/10.1007/s11906-003-0060-7
7. Fitzgerald SP, Bean NG, Falhammar H, Tuke J. Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis. Thyroid. 2020 Dec;30(12):1695-1709. doi: 10.1089/thy.2019.0535.
8. Irwin K. Endocrine Disorders and Cardiovascular Disease. In: Douglas ZP, Peter L, Robert BE.,Eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.ed 10th. Philadelphia, PA: Library of Congress; 2015: p. 1798–1805.
9. Fadel BM, Ellahham S, Ringel MD, Lindsay J Jr, Wartofsky L, Burman KD. Hyperthyroid heart disease. Clin Cardiol. 2000 Jun;23(6):402-8.
10. Brandt F, Green A, Hegedüs L, Brix TH. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality. Eur J Endocrinol 2011; 165:491-497
11. Toft P, Botker HE: Hyperthyroidism and heart disease. Is thyrotoxic cardiomyopathy a disease entity? [Article in Danish]. Ugeskr Laeger. 1993, 55:1354-7.
12. Vale, C., Neves, J.S., von Hafe, M. et al. The Role of Thyroid Hormones in Heart Failure. Cardiovasc Drugs Ther 33, 179–188 (2019). https://doi.org/10.1007/s10557-019-06870-4
13. Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol. 2017;14(1):39–55
14. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379(9821):1142–54.
15. Ojamaa K, Klemperer JD, MacGilvray SS, Klein I, Samarel A. Thyroid hormone and hemodynamic regulation of beta-myosin heavy chain promoter in the heart. Endocrinology.1996; 137( 3): 802–808.https://doi.org/10.1210/endo.137.3.8603588
16. Kiss E, Jakab G, Kranias EG, Edes I: Thyroid hormone-induced alterations in phospholamban protein expression. Regulatory effects on sarcoplasmic reticulum Ca2+ transport and myocardial relaxation. Circ Res. 1994, 75:245-251. 10.1161/01.res.75.2.245.
17. Kasturi S, Ismail-Beigi F: Effect of thyroid hormone on the distribution and activity of Na, K-ATPase in ventricular myocardium. Arch Biochem Biophys. 2008, 475:121-127.
18. Hadi A, Yaqoob Z, Sardar T, Shafiq, Ain N, Hanan F. Histopathologic Patterns and cytologic Correlation of ThyroidLesions among Patients with Thyroid Biopsies in PMC Peshawar KPK, Pakistan. IJCMCR. 2022; 21(1): 1-7.
19. Khurana NK, Kumar S, Kumar S, Kumar P, Rizwan A. Frequency of Cardiovascular Manifestation in Patients With Hyperthyroidism. Cureus. 2021 ;13(1):e12839.
20. Iqbal MA, Rashid S, Sadaqat S, Junaid N, Rizwan M. Common Clinical signs and symptoms observed in Patients diagnosed with Thyrotoxicosis in Gujranwala, Pakistan. PJMH. 2023;17(02):123-125.
21. Nijith L, Ranjan R. Cardiovascular Manifestations in Hyperthyroidism: A Cross-Sectional Study in a Tertiary Care Hospital in South India. Cureus. 2022 May 23;14(5):e25232.
22. Kandan V, Sathyamurthy P, Rajkumar M, Narayanan L. Cardiovascular manifestations in hyperthyroidism. Int J Res Med Sci. 2016 Jul;4(7):3032-3038.
23. Zargar AH, Bashir MI, Wani AI, Laway BA, Masoodi SR, Ganie MAet al. Clinical and endocrine aspects of thyrotoxicosis and its cardiovascular complications. Ann Saudi Med. 2000;20(5-6):485-7.
24. Bar-Sela S, Ehrenfeld M, Eliakim M. Arterial Embolism in Thyrotoxicosis with Atrial Fibrillation. Arch Intern Med. 1981;141(9):1191–1192.
25. Mercé J, Ferrás S, Oltra C, Sanz E, Vendrell J, Simón Iet al. Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study. Am J Med. 2005118(2):126-31.
26. Siu CW, Zhang XH, Yung C, Kung AW, Lau CP, Tse HF. Hemodynamic changes in hyperthyroidism-related pulmonary hypertension: a prospective echocardiographic study. JClinicEndocrinoMetabo.2007;92(5):1736-42.

Most read articles by the same author(s)