Login Register Cart 0
Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
General Research Article

Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves’ Disease Before and After Anti-Thyroid Therapy

Author(s): Gamze Akkuş*, Yeliz Sökmen, Mehmet Yılmaz, Özkan Bekler and Oğuz Akkuş

Volume 21, Issue 1, 2021

Published on: 29 July, 2020

Page: [183 - 191] Pages: 9

DOI: 10.2174/1871530320666200729145100

Price: $65

Abstract

Background: We aimed prospectively to investigate the laboratory and electrocardiographic parameters (heart rate, QRS, QT, QTc, Tpe, Tpe/QTc, and arrhythmia prevalence) in patients with Graves’ disease before and after antithyroid therapy.

Methods: Seventy-one patients (48 female, and 23 male), of age between 18-50 years (mean±SD: 36.48±12.20) with GD were included in the study. Patients were treated with antithyroid therapy (thioamides and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment.

Results: Mean TSH, free thyroxin (fT4), and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious malignant nodule or large goiter, and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to a medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise, the baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients came at their euthyroid status, group 2 patients still suffered from more sustained supraventricular ectopics beats than group 1.

Conclusion: Distinct from the medical treatment group, surgical treatment group with euthyroidism for at least 3 months still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

Keywords: Thyrotoxicosis, arrhythmia, anti-thyroid therapy, Graves’ Disease, hyperthyroidism, electrocardiogram.

« Previous Next »
Graphical Abstract

[1]
Kahaly, G.J.; Bartalena, L.; Hegedüs, L.; Leenhardt, L.; Poppe, K.; Pearce, S.H. 2018 European Thyroid association guideline for the management of Graves’ hyperthyroidism. Eur. Thyroid J., 2018, 7(4), 167-186.
[http://dx.doi.org/10.1159/000490384] [PMID: 30283735]
[2]
Gussekloo, J.; van Exel, E.; de Craen, A.J.; Meinders, A.E.; Frölich, M.; Westendorp, R.G. Thyroid status, disability and cognitive function, and survival in old age. JAMA, 2004, 292(21), 2591-2599.
[http://dx.doi.org/10.1001/jama.292.21.2591] [PMID: 15572717]
[3]
Tsymbaliuk, I; Unukovych, D; Shvets; N, Dinets A Cardiovascular complications secondary to Graves’ disease: a prospective study from Ukraine. Plos One, 2015, 10 0..
[4]
Klein, I.; Ojamaa, K. Thyroid hormone and the cardiovascular system. N. Engl. J. Med., 2001, 344(7), 501-509.
[http://dx.doi.org/10.1056/NEJM200102153440707] [PMID: 11172193]
[5]
Klein, I.; Danzi, S. Thyroid disease and the heart. Curr. Probl. Cardiol., 2016, 41(2), 65-92.
[http://dx.doi.org/10.1016/j.cpcardiol.2015.04.002] [PMID: 26792255]
[6]
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. 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]
[7]
Franklyn, J.A.; Maisonneuve, P.; Sheppard, M.C.; Betteridge, J.; Boyle, P. Mortality after the treatment of hyperthyroidism with radioactive iodine. N. Engl. J. Med., 1998, 338(11), 712-718.
[http://dx.doi.org/10.1056/NEJM199803123381103] [PMID: 9494147]
[8]
Hall, P.; Lundell, G.; Holm, L.E. Mortality in patients treated for hyperthyroidism with iodine-131. Acta Endocrinol. (Copenh.), 1993, 128(3), 230-234.
[http://dx.doi.org/10.1530/acta.0.1280230] [PMID: 8480472]
[9]
Bartalena, L.; Baldeschi, L.; Dickinson, A.; Eckstein, A.; Kendall-Taylor, P.; Marcocci, C.; Mourits, M.; Perros, P.; Boboridis, K.; Boschi, A.; Currò, N.; Daumerie, C.; Kahaly, G.J.; Krassas, G.E.; Lane, C.M.; Lazarus, J.H.; Marinò, M.; Nardi, M.; Neoh, C.; Orgiazzi, J.; Pearce, S.; Pinchera, A.; Pitz, S.; Salvi, M.; Sivelli, P.; Stahl, M.; von Arx, G.; Wiersinga, W.M. European group on Graves’ orbitopathy (EUGOGO). Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur. J. Endocrinol., 2008, 158(3), 273-285.
[http://dx.doi.org/10.1530/EJE-07-0666] [PMID: 18299459]
[10]
Castro Hevia, J.; Antzelevitch, C.; Tornés Bárzaga, F.; Dorantes Sánchez, M.; Dorticós Balea, F.; Zayas Molina, R.; Quiñones Pérez, M.A.; Fayad Rodríguez, Y. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J. Am. Coll. Cardiol., 2006, 47(9), 1828-1834.
[http://dx.doi.org/10.1016/j.jacc.2005.12.049] [PMID: 16682308]
[11]
Chen, Q.; Yan, Y.; Zhang, L.; Cheng, K.; Liu, Y.; Zhu, W. Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation. Cardiology, 2014, 127(3), 176-182.
[http://dx.doi.org/10.1159/000356954]
[12]
Siu, C.W.; Yeung, C.Y.; Lau, C.P.; Kung, A.W.; Tse, H.F. Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart, 2007, 93(4), 483-487.
[http://dx.doi.org/10.1136/hrt.2006.100628] [PMID: 17005710]
[13]
Dörr, M.; Ruppert, J.; Robinson, D.M.; Kors, J.A.; Felix, S.B.; Völzke, H. The relation of thyroid function and ventricular repolarization: decreased serum thyrotropin levels are associated with short rate-adjusted QT intervals. J. Clin. Endocrinol. Metab., 2006, 91(12), 4938-4942.
[http://dx.doi.org/10.1210/jc.2006-1017] [PMID: 16968798]
[14]
Kaminski, G.; Makowski, K.; Michałkiewicz, D.; Kowal, J.; Ruchala, M.; Szczepanek, E.; Gielerak, G. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid, 2012, 22(5), 454-460.
[http://dx.doi.org/10.1089/thy.2010.0333] [PMID: 22510014]
[15]
Oliveros-Ruiz, L; Vallejo, M; Diez Canseco, LF; Cardenas, M; Hermosillo, JA Determinants of thyrotoxic cardiomyopathy recovery. BioMed research international, 2013.452709 Epub 2013/10/10
[http://dx.doi.org/10.1155/2013/452709]
[16]
Dahl, P.; Danzi, S.; Klein, I. Thyrotoxic cardiac disease. Curr. Heart Fail. Rep., 2008, 5(3), 170-176.
[http://dx.doi.org/10.1007/s11897-008-0026-9] [PMID: 18752767]
[17]
Yamaguchi, M.; Shimizu, M.; Ino, H.; Terai, H.; Uchiyama, K.; Oe, K.; Mabuchi, T.; Konno, T.; Kaneda, T.; Mabuchi, H. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin. Sci. (Lond.), 2003, 105(6), 671-676.
[http://dx.doi.org/10.1042/CS20030010] [PMID: 12857349]
[18]
Tse, G.; Gong, M.; Wong, W.T.; Georgopoulos, S.; Letsas, K.P.; Vassiliou, V.S.; Chan, Y.S.; Yan, B.P.; Wong, S.H.; Wu, W.K.K.; Ciobanu, A.; Li, G.; Shenthar, J.; Saguner, A.M.; Ali-Hasan-Al-Saegh, S.; Bhardwaj, A.; Sawant, A.C.; Whittaker, P.; Xia, Y.; Yan, G.X.; Liu, T. The Tpeak - Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis. Heart Rhythm, 2017, 14(8), 1131-1137.
[http://dx.doi.org/10.1016/j.hrthm.2017.05.031] [PMID: 28552749]
[19]
Ciobanu, A.; Tse, G.; Liu, T.; Deaconu, M.V.; Gheorghe, G.S.; Ilieşiu, A.M. (2107) Electrocardiographic measures of repolarization dispersion and their relationships with echocardiographic indices of ventricular remodeling and premature ventricular beats in hypertension. J. Geriatr. Cardiol., 2017, 14(12), 717-724.
[http://dx.doi.org/10.11909/j.issn.1671-5411.2017.12.001] [PMID: 29581710]
[20]
Panikkath, R.; Reinier, K.; Uy-Evanado, A.; Teodorescu, C.; Hattenhauer, J.; Mariani, R.; Gunson, K.; Jui, J.; Chugh, S.S. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol, 2011, 4(4), 441-447.
[http://dx.doi.org/10.1161/CIRCEP.110.960658] [PMID: 21593198]
[21]
Zhang, Y.; Post, W.S.; Cheng, A.; Blasco-Colmenares, E.; Tomaselli, G.F.; Guallar, E. Thyroid hormones and electrocardiographic parameters: findings from the third national health and nutrition examination survey. PLoS One, 2013, 8(4)e59489
[http://dx.doi.org/10.1371/journal.pone.0059489] [PMID: 23593140]
[22]
Dillmann, W.H. Cellular action of thyroid hormone on the heart. Thyroid, 2002, 12(6), 447-452.
[http://dx.doi.org/10.1089/105072502760143809] [PMID: 12165105]
[23]
Kiss, E.; Jakab, G.; Kranias, E.G.; Edes, I. Thyroid hormone-induced alterations in phospholamban protein expression. Regulatory effects on sarcoplasmic reticulum Ca2+ transport and myocardial relaxation. Circ. Res., 1994, 75(2), 245-251.
[http://dx.doi.org/10.1161/01.RES.75.2.245] [PMID: 8033338]
[24]
Sugiura, T.; Yamanaka, S.; Takeuchi, H.; Morimoto, N.; Kamioka, M.; Matsumura, Y. Autoimmunity and pulmonary hypertension in patients with Graves’ disease. Heart Vessels, 2015, 30(5), 642-646.
[http://dx.doi.org/10.1007/s00380-014-0518-3] [PMID: 24838983]
[25]
Vallabhajosula, S.; Radhi, S.; Cevik, C.; Alalawi, R.; Raj, R.; Nugent, K. Hyperthyroidism and pulmonary hypertension: an important association. Am. J. Med. Sci., 2011, 342(6), 507-512.
[http://dx.doi.org/10.1097/MAJ.0b013e31821790f4] [PMID: 22112709]
[26]
Nanchen, D.; Gussekloo, J.; Westendorp, R.G.; Stott, D.J.; Jukema, J.W.; Trompet, S.; Ford, I.; Welsh, P.; Sattar, N.; Macfarlane, P.W.; Mooijaart, S.P.; Rodondi, N.; de Craen, A.J. PROSPER Group. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J. Clin. Endocrinol. Metab., 2012, 97(3), 852-861.
[http://dx.doi.org/10.1210/jc.2011-1978] [PMID: 22238391]
[27]
Gopinathannair, R.; Etheridge, S.P.; Marchlinski, F.E.; Spinale, F.G.; Lakkireddy, D.; Olshansky, B. Arrhythmia-induced cardiomyopathies: mechanisms, recognition, and management. J. Am. Coll. Cardiol., 2015, 66(15), 1714-1728.
[http://dx.doi.org/10.1016/j.jacc.2015.08.038] [PMID: 26449143]
[28]
Mueller, K.A.L.; Heinzmann, D.; Klingel, K.; Fallier-Becker, P.; Kandolf, R.; Kilias, A.; Walker-Allgaier, B.; Borst, O.; Kumbrink, J.; Kirchner, T.; Langer, H.; Geisler, T.; Schreieck, J.; Gramlich, M.; Gawaz, M.; Seizer, P. Histopathological and immunological characteristics of tachycardia-induced cardiomyopathy. J. Am. Coll. Cardiol., 2017, 69(17), 2160-2172.
[http://dx.doi.org/10.1016/j.jacc.2017.02.049] [PMID: 28449778]
[29]
Osman, F.; Franklyn, J.A.; Holder, R.L.; Sheppard, M.C.; Gammage, M.D. Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. J. Am. Coll. Cardiol., 2007, 49(1), 71-81.
[http://dx.doi.org/10.1016/j.jacc.2006.08.042] [PMID: 17207725]
[30]
Nakazawa, H.K.; Sakurai, K.; Hamada, N.; Momotani, N.; Ito, K. Management of atrial fibrillation in the post-thyrotoxic state. Am. J. Med., 1982, 72(6), 903-906.
[http://dx.doi.org/10.1016/0002-9343(82)90850-6]
[31]
Von Olshausen, K.; Bischoff, S.; Kahaly, G.; Mohr-Kahaly, S.; Erbel, R.; Beyer, J.; Meyer, J. Cardiac arrhythmias and heart rate in hyperthyroidism. Am. J. Cardiol., 1989, 63(13), 930-933.
[http://dx.doi.org/10.1016/0002-9149(89)90142-2] [PMID: 2929466]
[32]
Gauthier, J.M.; Mohamed, H.E.; Noureldine, S.I.; Nazari-Shafti, T.Z.; Thethi, T.K.; Kandil, E. Impact of thyroidectomy on cardiac manifestations of Graves’ disease. Laryngoscope, 2016, 126(5), 1256-1259.
[http://dx.doi.org/10.1002/lary.25687] [PMID: 26927707]
[33]
Burggraaf, J.; Lalezari, S.; Emeis, J.J.; Vischer, U.M.; de Meyer, P.H.; Pijl, H.; Cohen, A.F. Endothelial function in patients with hyperthyroidism before and after treatment with propranolol and thiamazol. Thyroid, 2001, 11(2), 153-160.
[http://dx.doi.org/10.1089/105072501300042820] [PMID: 11288984]
[34]
Northcote, R.J.; MacFarlane, P.; Kesson, C.M.; Ballantyne, D. Continuous 24-hour electrocardiography in thyrotoxicosis before and after treatment. Am. Heart J., 1986, 112(2), 339-344.
[http://dx.doi.org/10.1016/0002-8703(86)90272-3] [PMID: 2426935]

Rights & Permissions Print Cite
Article Metrics
6
1
© 2024 Bentham Science Publishers | Privacy Policy