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Cardiology483 papers

Hyperthyroidism

Last edited: 29 days ago

Overview

Hyperthyroidism is characterized by excessive production of thyroid hormones, often due to Graves' disease, leading to a spectrum of systemic effects including cardiovascular, metabolic, and musculoskeletal manifestations. 4822

Diagnosis

  • Clinical Symptoms: Weight loss, palpitations, tremors, heat intolerance, anxiety, and goiter. 424
  • Laboratory Tests: Low TSH, elevated free T4 (FT4), and sometimes elevated T3. 42422
  • Additional Assessments: Thyroid-stimulating hormone receptor antibodies for Graves' disease, echocardiography for cardiac involvement. 72530
  • Management

  • First-Line Treatments:
  • - Antithyroid Drugs: Carbimazole or methimazole (dose varies; monitor for agranulocytosis). 3511 - Radioactive Iodine (RAI): Effective for definitive treatment, particularly in adults. 41027 - Surgery: Thyroidectomy for refractory cases or large goiters. 41027
  • Adjunctive Treatments:
  • - Beta-Blockers: For symptomatic relief (e.g., atenolol for tachycardia in cats). 7630 - Calcium Channel Blockers: For hypertension and cardiac remodeling (e.g., diltiazem). 1739

    Special Populations

  • Pregnancy: Propylthiouracil preferred over methimazole to avoid fetal thyroid suppression; close monitoring required. 1159
  • Elderly: Increased risk of cardiovascular complications; careful management of heart failure and atrial fibrillation. 2355
  • Comorbidities: Attention to potential interactions and exacerbation of conditions like atrial fibrillation and osteoporosis. 335773
  • Key Recommendations

  • Initiate treatment with antithyroid drugs, RAI, or surgery based on patient preference, disease severity, and comorbidities (Evidence: Moderate 41027).
  • Use beta-blockers for symptomatic relief in hyperthyroid patients to manage tachycardia and anxiety (Evidence: Moderate 7630).
  • Monitor for and manage cardiovascular complications, especially in elderly patients and those with preexisting heart disease (Evidence: Moderate 2355).
  • In pregnant women, propylthiouracil is preferred over methimazole to minimize fetal thyroid suppression (Evidence: Moderate 1159).
  • Regular follow-up is essential to assess thyroid function and manage potential long-term cardiovascular risks post-treatment (Evidence: Moderate 5575).
  • References

    Showing 100 most recent of 255 indexed papers.

    1 Pan Y, Zhou S, Luo D. Hyperthyroidism drives gout risk: A Mendelian randomization observational study. Medicine 2026. link 2 Liu N, Zhang S, Liu Y, Lu X, He X. Potential Mechanisms Underlying Carbimazole-Induced Cardiotoxicity and Hepatotoxicity in Zebrafish. Journal of applied toxicology : JAT 2026. link 3 Ramírez Stieben LA, Brun LR, Nasazzi Doddi P, Brance ML. Antithyroid drugs and the dose-risk balance: a meta-analysis on agranulocytosis in hyperthyroidism. Endocrine 2025. link 4 Kim KJ, Song E, Kim M, Kwon H, Ku EJ, Kwon HW et al.. 2025 Korean Thyroid Association Management Guidelines for Radioactive Iodine Therapy in Patients with Hyperthyroidism. Endocrinology and metabolism (Seoul, Korea) 2025. link 5 Li Y, Li H, Sun Q, Long Q. A disproportionality analysis of FDA adverse event reporting system (FAERS) events for methimazole and propylthiouracil. PloS one 2025. link 6 Lee JY, Park SY, Sohn SY. Increased risk of incident gout in patients with hyperthyroidism: a nationwide retrospective cohort study. Rheumatology international 2024. link 7 Brenner R, Drescher T, Locher R, Bilz S, Rickli H, Brändle M et al.. Pulmonary and Systemic Hemodynamics in Patients with Hyperthyroidism. The American journal of medicine 2024. link 8 Iglesias P, Benavent M, López G, Arias J, Romero I, Díez JJ. Hyperthyroidism and cardiovascular disease: an association study using big data analytics. Endocrine 2024. link 9 Shokri F, Zarei M, Komaki A, Raoufi S, Ramezani-Aliakbari F. Effect of diminazene on cardiac hypertrophy through mitophagy in rat models with hyperthyroidism induced by levothyroxine. Naunyn-Schmiedeberg's archives of pharmacology 2024. link 10 Peng CC, Lin YJ, Lee SY, Lin SM, Han C, Loh CH et al.. MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy. JAMA network open 2024. link 11 Liu Y, Li Q, Xu Y, Chen Y, Men Y. Comparison of the safety between propylthiouracil and methimazole with hyperthyroidism in pregnancy: A systematic review and meta-analysis. PloS one 2023. link 12 Lee H, Lee D, Park J, Yun T, Koo Y, Chae Y et al.. Heart failure in a cat due to hypertrophic cardiomyopathy phenotype caused by chronic uncontrolled hyperthyroidism. Acta veterinaria Hungarica 2023. link 13 Bode H, Ivens B, Bschor T, Schwarzer G, Henssler J, Baethge C. Hyperthyroidism and clinical depression: a systematic review and meta-analysis. Translational psychiatry 2022. link 14 Kesici U, Karatepe YK, Isceviren B. Concurrence of Thyrolipomatosis with Hyperthyroidism and Ectopic Thyroid Tissue. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2022. link 15 Yamaguchi Y, Uchimura K, Takahashi K, Ishii T, Hanai S, Furuya F. Hyperthyroidism exacerbates ischemic reperfusion injury in the kidney. Endocrine journal 2022. link 16 Lachance L, Conversy B, Wiggen K, Pavard C, Reinero C, Masseau I. No evidence of pulmonary hypertension revealed in an echographic evaluation of right-sided hemodynamics in hyperthyroid cats. Journal of feline medicine and surgery 2022. link 17 Khamis T, Alsemeh AE, Abdullah DM. Sacubitril/valsartan (LCZ696) ameliorates hyperthyroid-induced cardiac hypertrophy in male rats through modulation of miR-377, let-7 b, autophagy, and fibrotic signaling pathways. Scientific reports 2022. link 18 Koyama K, Anno T, Kawasaki F, Nishino K, Kawamoto H, Kaneto H et al.. Edematous wall thickening of the gallbladder induced by hyperthyroidism: A case report. Medicine 2022. link 19 Ganesan K, Bradley B, Jones DW, Solomon DS. A Case Report on Type 2 Amiodarone Induced Thyrotoxicosis and Hypercalcemia. The American journal of the medical sciences 2021. link 20 Riva MA, Paleari A, Belingheri M. At the origin of "Endocrinology and Art": Woman's Head (third century BCE). Journal of endocrinological investigation 2020. link 21 Hu X, Zhang H, Song Y, Wu C, Yang Q, Shi Z et al.. Implementation of flipped classroom combined with problem-based learning: an approach to promote learning about hyperthyroidism in the endocrinology internship. BMC medical education 2019. link 22 Bel Lassen P, Kyrilli A, Lytrivi M, Corvilain B. Graves' disease, multinodular goiter and subclinical hyperthyroidism. Annales d'endocrinologie 2019. link 23 Tamatea JAU, Elston MS, Conaglen JV. Increased Admissions Due to Cardiac Complications of Thyrotoxicosis in Māori. Heart, lung & circulation 2019. link 24 Andrade GC, Maia FCP, Mourão GF, Rosario PW, Calsolari MR. Antineutrophil cytoplasmic antibodies in patients treated with methimazole: a prospective Brazilian study. Brazilian journal of otorhinolaryngology 2019. link 25 Gazzana ML, Souza JJ, Okoshi MP, Okoshi K. Prospective Echocardiographic Evaluation of the Right Ventricle and Pulmonary Arterial Pressure in Hyperthyroid Patients. Heart, lung & circulation 2019. link 26 Yazidi M, Chihaoui M, Oueslati H, Chaker F, Rjeb O, Rjaibi S et al.. Cardiothyreosis: Prevalence and risk factors. Annales d'endocrinologie 2019. link 27 Giesecke P, Frykman V, Wallin G, Lönn S, Discacciati A, Törring O et al.. All-cause and cardiovascular mortality risk after surgery versus radioiodine treatment for hyperthyroidism. The British journal of surgery 2018. link 28 Takano APC, Senger N, Munhoz CD, Barreto-Chaves MLM. AT1 receptor blockage impairs NF-κB activation mediated by thyroid hormone in cardiomyocytes. Pflugers Archiv : European journal of physiology 2018. link 29 Wu JB, Zhou Y, Liang CL, Zhang XJ, Lai JM, Ye SF et al.. Cyclovirobuxinum D alleviates cardiac hypertrophy in hyperthyroid rats by preventing apoptosis of cardiac cells and inhibiting the p38 mitogen-activated protein kinase signaling pathway. Chinese journal of integrative medicine 2017. link 30 Carney HC, Ward CR, Bailey SJ, Bruyette D, Dennis S, Ferguson D et al.. 2016 AAFP Guidelines for the Management of Feline Hyperthyroidism. Journal of feline medicine and surgery 2016. link 31 Singh BK, Pillai KK, Kohli K, Haque SE. Cissampelos pareira Linn. ameliorates thyroxin-induced cardiac hypertrophy in rats. Journal of ethnopharmacology 2016. link 32 Foppiani L, Cascio C, Lo Pinto G. Iodine-induced hyperthyroidism as combination of different etiologies: an overlooked entity in the elderly. Aging clinical and experimental research 2016. link 33 Ittermann T, Bahls M, Atzler D, Friedrich N, Schwedhelm E, Böger RH et al.. L-Arginine Derivatives Are Associated with the Hyperthyroid State in the General Population. Thyroid : official journal of the American Thyroid Association 2016. link 34 Goichot B, Caron P, Landron F, Bouée S. Clinical presentation of hyperthyroidism in a large representative sample of outpatients in France: relationships with age, aetiology and hormonal parameters. Clinical endocrinology 2016. link 35 Rosario PW, Carvalho M, Calsolari MR. Symptoms of thyrotoxicosis, bone metabolism and occult atrial fibrillation in older women with mild endogenous subclinical hyperthyroidism. Clinical endocrinology 2016. link 36 Galloway A, Li H, Vanderlinde-Wood M, Khan M, Benbrook A, Liles C et al.. Activating autoantibodies to the β1/2-adrenergic and M2 muscarinic receptors associate with atrial tachyarrhythmias in patients with hyperthyroidism. Endocrine 2015. link 37 Hernández-Esquivel L, Pavón N, Buelna-Chontal M, González-Pacheco H, Belmont J, Chávez E. Cardioprotective properties of citicoline against hyperthyroidism-induced reperfusion damage in rat hearts. Biochemistry and cell biology = Biochimie et biologie cellulaire 2015. link 38 Tonstad S, Nathan E, Oda K, Fraser GE. Prevalence of hyperthyroidism according to type of vegetarian diet. Public health nutrition 2015. link 39 Freitas F, Estato V, Lessa MA, Tibiriçá E. Cardiac microvascular rarefaction in hyperthyroid rats is reversed by losartan, diltiazem, and propranolol. Fundamental & clinical pharmacology 2015. link 40 Diaconescu MR, Costea I, Glod M, Diaconescu S. Cardiothyreosis: Pathogenic Conjectures, Clinical Aspects and Surgical Approach. Chirurgia (Bucharest, Romania : 1990) 2015. link 41 Sangster JK, Panciera DL, Abbott JA, Zimmerman KC, Lantis AC. Cardiac biomarkers in hyperthyroid cats. Journal of veterinary internal medicine 2014. link 42 Bowlt K, Cattin I, Stewart J. Carbimazole-associated hypersensitivity vasculitis in a cat. The Journal of small animal practice 2014. link 43 Ryödi E, Salmi J, Jaatinen P, Huhtala H, Saaristo R, Välimäki M et al.. Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up. Clinical endocrinology 2014. link 44 Ramoo S, Bradbury LA, Anderson GA, Abraham LA. Sedation of hyperthyroid cats with subcutaneous administration of a combination of alfaxalone and butorphanol. Australian veterinary journal 2013. link 45 Kao YH, Chang TJ, Huang TS. Thyrotropin-secreting pituitary tumor presenting with congestive heart failure and good response to dopaminergic agonist cabergoline. Journal of the Formosan Medical Association = Taiwan yi zhi 2013. link 46 Kwon EN, Kambalapalli M, Francis G, Donofrio MT. Fetal right-ventricular hypertrophy with pericardial effusion and maternal untreated hyperthyroidism. Pediatric cardiology 2013. link 47 Kim BH, Cho KI, Kim SM, Kim N, Han J, Kim JY et al.. Heart rate reduction with ivabradine prevents thyroid hormone-induced cardiac remodeling in rat. Heart and vessels 2013. link 48 Ellis H. Robert Graves: Graves' disease of the thyroid. Journal of perioperative practice 2012. link 49 Na W, Peng G, Jianping Z, Yanzhong C, Shengjiang G, Li C. RhoA/ROCK may involve in cardiac hypertrophy induced by experimental hyperthyroidism. Toxicology and industrial health 2012. link 50 Wong SM, Tse HF, Siu CW. Pulmonary hypertension and isolated right heart failure complicating amiodarone induced hyperthyroidism. Heart, lung & circulation 2012. link 51 Bonou M, Lampropoulos KM, Andriopoulou M, Kotsas D, Lakoumentas J, Barbetseas J. Severe tricuspid regurgitation and isolated right heart failure due to thyrotoxicosis. Indian heart journal 2012. link 52 Ghandour A, Reust C. Hyperthyroidism: a stepwise approach to management. The Journal of family practice 2011. link 53 Catalano C, Caridi G, Postorino MC, Enia G. Hypokalaemia with paralysis: don't forget the thyroid. BMJ case reports 2011. link 54 Bahn 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. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2011. link 55 Araujo AS, Diniz GP, Seibel FE, Branchini G, Ribeiro MF, Brum IS et al.. Reactive oxygen and nitrogen species balance in the determination of thyroid hormones-induced cardiac hypertrophy mediated by renin-angiotensin system. Molecular and cellular endocrinology 2011. link 56 Franchini M, Lippi G, Targher G. Hyperthyroidism and venous thrombosis: a casual or causal association? A systematic literature review. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2011. link 57 Patanè S, Marte F, Sturiale M. Endogenous subclinical hyperthyroidism and cardiovascular system: time to reconsider?. International journal of cardiology 2011. link 58 Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Archives of gynecology and obstetrics 2011. link 59 Ivanović B, Tadić M, Simić D. Isolated right-sided heart failure in a patient with hyperthyroidism. Acta clinica Croatica 2011. link 60 Yue WS, Chong BH, Zhang XH, Liao SY, Jim MH, Kung AW et al.. Hyperthyroidism-induced left ventricular diastolic dysfunction: implication in hyperthyroidism-related heart failure. Clinical endocrinology 2011. link 61 Mukhopadhyay S, Satpathi T. Retrosternal goitre with subclinical hyperthyroidism presenting with trochanteric fracture. The Journal of the Association of Physicians of India 2010. link 62 Rivkees SA, Szarfman A. Dissimilar hepatotoxicity profiles of propylthiouracil and methimazole in children. The Journal of clinical endocrinology and metabolism 2010. link 63 Gen R, Akbay E, Camsari A, Ozcan T. P-wave dispersion in endogenous and exogenous subclinical hyperthyroidism. Journal of endocrinological investigation 2010. link 64 Patanè S, Marte F. Changing axis deviation and paroxysmal atrial flutter associated with subclinical hyperthyroidism. International journal of cardiology 2010. link 65 Yu Z, Huang CX, Wang SY, Wang T, Xu L. Thyroid hormone predisposes rabbits to atrial arrhythmias by shortening monophasic action period and effective refractory period: results from an in vivo study. Journal of endocrinological investigation 2009. link 66 Supornsilchai V, Sahakitrungruang T, Wongjitrat N, Wacharasindhu S, Suphapeetiporn K, Shotelersuk V. Expanding clinical spectrum of non-autoimmune hyperthyroidism due to an activating germline mutation, p.M453T, in the thyrotropin receptor gene. Clinical endocrinology 2009. link 67 Erem C, Ucuncu O, Yilmaz M, Kocak M, Nuhoglu İ, Ersoz HO. Increased thrombin-activatable fibrinolysis inhibitor and decreased tissue factor pathway inhibitor in patients with hyperthyroidism. Endocrine 2009. link 68 Ertugrul DT, Yavuz B, Ata N, Yalcin AA, Kucukazman M, Algul B et al.. Decreasing brain natriuretic peptide levels after treatment for hyperthyroidism. Endocrine journal 2009. link 69 Marx H, Amin P, Lazarus JH. Hyperthyroidism and pregnancy. BMJ (Clinical research ed.) 2008. link 70 Bonucchi J, Hassan I, Policeni B, Kaboli P. Thyrotoxicosis associated Wernicke's encephalopathy. Journal of general internal medicine 2008. link 71 Trapali C, Dellagrammaticas HD, Nika A, Iacovidou N. A unique case of reversible myocardial ischemia in a hyperthyroid neonate. Pediatric cardiology 2008. link 72 Wu CZ, Wu YK, Lin JD, Kuo SW. Thyrotoxic periodic paralysis complicated by acute hypercapnic respiratory failure and ventricular tachycardia. Thyroid : official journal of the American Thyroid Association 2008. link 73 Rosario PW. Bone and heart abnormalities of subclinical hyperthyroidism in women below the age of 65 years. Arquivos brasileiros de endocrinologia e metabologia 2008. link 74 Araujo AS, Schenkel P, Enzveiler AT, Fernandes TR, Partata WA, Llesuy S et al.. The role of redox signaling in cardiac hypertrophy induced by experimental hyperthyroidism. Journal of molecular endocrinology 2008. link 75 Metso S, Auvinen A, Salmi J, Huhtala H, Jaatinen P. Increased long-term cardiovascular morbidity among patients treated with radioactive iodine for hyperthyroidism. Clinical endocrinology 2008. link 76 Henik RA, Stepien RL, Wenholz LJ, Dolson MK. Efficacy of atenolol as a single antihypertensive agent in hyperthyroid cats. Journal of feline medicine and surgery 2008. link 77 Dahl P, Danzi S, Klein I. Thyrotoxic cardiac disease. Current heart failure reports 2008. link 78 Di Giovambattista R. Hyperthyroidism as a reversible cause of right ventricular overload and congestive heart failure. Cardiovascular ultrasound 2008. link 79 Toft A, Sandeep TC. Radioiodine treatment of hyperthyroidism. BMJ (Clinical research ed.) 2007. link 80 Fernandes ML, Ferro EA, Beletti ME, Resende ES. Spironolactone effects on myocardium changes induced by thyroid hormone in rats. Arquivos brasileiros de cardiologia 2007. link 81 Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD. Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. Journal of the American College of Cardiology 2007. link 82 Siu CW, Yeung CY, Lau CP, Kung AW, Tse HF. Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart (British Cardiac Society) 2007. link 83 Kumar G, Chow JT, Klarich KW, Dean DS. Hyperthyroidism and atrial myxoma--an intriguing cardio-endocrine association. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2007. link 84 Ismail HM. Reversible pulmonary hypertension and isolated right-sided heart failure associated with hyperthyroidism. Journal of general internal medicine 2007. link 85 Vonhoff C, Baumgartner A, Hegger M, Korte B, Biller A, Winterhoff H. Extract of Lycopus europaeus L. reduces cardiac signs of hyperthyroidism in rats. Life sciences 2006. link 86 Takasugi H, Ao K, Sato T, Maeda A, Okada T, Wakiguchi H. Atrial fibrillation with hyperthyroidism in a 14-year-old male. Pediatric cardiology 2006. link 87 Marcisz C, Jonderko G, Wróblewski T, Kurzawska G, Mazur F. Left ventricular mass in patients with hyperthyroidism. Medical science monitor : international medical journal of experimental and clinical research 2006. link 88 Dörr M, Wolff B, Robinson DM, John U, Lüdemann J, Meng W et al.. The association of thyroid function with cardiac mass and left ventricular hypertrophy. The Journal of clinical endocrinology and metabolism 2005. link 89 Yamashita S, Tamiya T, Shindo A, Miyake K, Nakamura T, Ogawa D et al.. Improvement of cerebral arterial stenosis associated with Basedow's disease. Case report. Neurologia medico-chirurgica 2005. link 90 Moreno JM, Rodríguez Gómez I, Wangensteen R, Osuna A, Bueno P, Vargas F. Cardiac and renal antioxidant enzymes and effects of tempol in hyperthyroid rats. American journal of physiology. Endocrinology and metabolism 2005. link 91 Yang MJ, Cheng MH. Pregnancy complicated with pulmonary edema due to hyperthyroidism. Journal of the Chinese Medical Association : JCMA 2005. link70171-6) 92 Whitner TE, Hudson CJ, Smith TD, Littmann L. Hyperthyroidism presenting as isolated tricuspid regurgitation and right heart failure. Texas Heart Institute journal 2005. link 93 Kavak A, Kutluay L. Unilateral nevoid telangiectasia and hyperthyroidism: a new association or coincidence?. The Journal of dermatology 2004. link 94 Pearce SH. Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK. Clinical endocrinology 2004. link 95 Sakaki T, Fujioka Y, Akagami T, Masai M, Shimizu H, Sakoda T et al.. Cardiac wall motion abnormalities observed in a patient with transient hyperthyroidism. Japanese heart journal 2004. link 96 Lozano HF, Sharma CN. Reversible pulmonary hypertension, tricuspid regurgitation and right-sided heart failure associated with hyperthyroidism: case report and review of the literature. Cardiology in review 2004. link 97 Yavuz DG, Yüksel M, Deyneli O, Ozen Y, Aydin H, Akalin S. Association of serum paraoxonase activity with insulin sensitivity and oxidative stress in hyperthyroid and TSH-suppressed nodular goitre patients. Clinical endocrinology 2004. link 98 McDermott MT, Woodmansee WW, Haugen BR, Smart A, Ridgway EC. The management of subclinical hyperthyroidism by thyroid specialists. Thyroid : official journal of the American Thyroid Association 2003. link 99 Takeuchi K, Minakawa M, Otaki M, Odagiri S, Itoh K, Murakami A et al.. Hyperthyroidism causes mechanical insufficiency of myocardium with possibly increased SR Ca2+-ATPase activity. The Japanese journal of physiology 2003. link 100 Hu LW, Benvenuti LA, Liberti EA, Carneiro-Ramos MS, Barreto-Chaves ML. Thyroxine-induced cardiac hypertrophy: influence of adrenergic nervous system versus renin-angiotensin system on myocyte remodeling. American journal of physiology. Regulatory, integrative and comparative physiology 2003. link

    Original source

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