Graves' disease natural history, complications and prognosis: Difference between revisions
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*When compared with people older than 60 years with a healthy thyroid, those who are hyperthyroid have three times the risk of atrial fibrillation.<ref name="pmid7935681">{{cite journal |vauthors=Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D'Agostino RB |title=Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons |journal=N. Engl. J. Med. |volume=331 |issue=19 |pages=1249–52 |year=1994 |pmid=7935681 |doi=10.1056/NEJM199411103311901 |url=}}</ref> | *When compared with people older than 60 years with a healthy thyroid, those who are hyperthyroid have three times the risk of atrial fibrillation.<ref name="pmid7935681">{{cite journal |vauthors=Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D'Agostino RB |title=Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons |journal=N. Engl. J. Med. |volume=331 |issue=19 |pages=1249–52 |year=1994 |pmid=7935681 |doi=10.1056/NEJM199411103311901 |url=}}</ref> | ||
*Embolic stroke related to atrial fibrillation secondary to hyperthyroidism is significantly more prevalent than embolic stroke related to atrial fibrillation from non-thyroidal causes.<ref name="pmid24434544">{{cite journal |vauthors=Chen Q, Yan Y, Zhang L, Cheng K, Liu Y, Zhu W |title=Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation |journal=Cardiology |volume=127 |issue=3 |pages=176–82 |year=2014 |pmid=24434544 |doi=10.1159/000356954 |url=}}</ref> | *Embolic stroke related to atrial fibrillation secondary to hyperthyroidism is significantly more prevalent than embolic stroke related to atrial fibrillation from non-thyroidal causes.<ref name="pmid24434544">{{cite journal |vauthors=Chen Q, Yan Y, Zhang L, Cheng K, Liu Y, Zhu W |title=Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation |journal=Cardiology |volume=127 |issue=3 |pages=176–82 |year=2014 |pmid=24434544 |doi=10.1159/000356954 |url=}}</ref> | ||
*Thyroid-Associated Ophthalmopathy | *AF is considered as an independent risk factor for CHF in patients with Graves' disease.<ref name="pmid17005710">{{cite journal |vauthors=Siu CW, Yeung CY, Lau CP, Kung AW, Tse HF |title=Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism |journal=Heart |volume=93 |issue=4 |pages=483–7 |year=2007 |pmid=17005710 |pmc=1861478 |doi=10.1136/hrt.2006.100628 |url=}}</ref> | ||
Cardiac manifestations of Graves' disease include Palpitations, anginal chest pain, exercise intolerance, atrial fibrillation, exertional dyspnea, cardiac hypertrophy, systolic hypertension, peripheral edema hyperdynamic precordium, pulmonary hypertension and heart failure.<ref name="pmid27811932">{{cite journal |vauthors=Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S |title=Thyroid hormones and cardiovascular disease |journal=Nat Rev Cardiol |volume=14 |issue=1 |pages=39–55 |year=2017 |pmid=27811932 |doi=10.1038/nrcardio.2016.174 |url=}}</ref> | |||
====Thyrotoxic periodic paralysis==== | |||
*It is characterised by the triad of muscle paralysis, acute hypokalaemia and thyrotoxicosis, and caused by a shift of potassium into the muscle cells.<ref name="pmid24695373">{{cite journal |vauthors=Vijayakumar A, Ashwath G, Thimmappa D |title=Thyrotoxic periodic paralysis: clinical challenges |journal=J Thyroid Res |volume=2014 |issue= |pages=649502 |year=2014 |pmid=24695373 |pmc=3945080 |doi=10.1155/2014/649502 |url=}}</ref> | |||
====Thyroid-Associated Ophthalmopathy==== | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Natural History, Complications and Prognosis
Natural History
If left untreated it may lead to serious complications such as, thyroid storm, life threatening arrhythmias, orbitopathies, weight loss and even osteoporosis.
Complications
Cardiac complications
- Older patients are more vulnerable to develop cardiovascular complications comparing to young people.[1]
- When compared with people older than 60 years with a healthy thyroid, those who are hyperthyroid have three times the risk of atrial fibrillation.[2]
- Embolic stroke related to atrial fibrillation secondary to hyperthyroidism is significantly more prevalent than embolic stroke related to atrial fibrillation from non-thyroidal causes.[3]
- AF is considered as an independent risk factor for CHF in patients with Graves' disease.[4]
Cardiac manifestations of Graves' disease include Palpitations, anginal chest pain, exercise intolerance, atrial fibrillation, exertional dyspnea, cardiac hypertrophy, systolic hypertension, peripheral edema hyperdynamic precordium, pulmonary hypertension and heart failure.[5]
Thyrotoxic periodic paralysis
- It is characterised by the triad of muscle paralysis, acute hypokalaemia and thyrotoxicosis, and caused by a shift of potassium into the muscle cells.[6]
Thyroid-Associated Ophthalmopathy
- Complications from surgery, including:
- Hoarseness from damage to the nerve leading to the voice box
- Low calcium levels from damage to the parathyroid glands (located near the thyroid gland)
- Scarring of the neck
- Eye problems (called Graves ophthalmopathy or exophthalmos
- Heart-related complications, including:
- Rapid heart rate
- Congestive heart failure (especially in the elderly)
- Atrial fibrillation
- Thyroid crisis (thyrotoxic storm), a severe worsening of overactive thyroid gland symptoms
- Increased risk for osteoporosis, if hyperthyroidism is present for a long time
- Complications related to thyroid hormone replacement
- If too little hormone is given, fatigue, weight gain, high cholesterol, depression, physical sluggishness, and other symptoms of hypothyroidism can occur
- If too much hormone is given, symptoms of hyperthyroidism will return
References
- ↑ Devereaux D, Tewelde SZ (2014). "Hyperthyroidism and thyrotoxicosis". Emerg. Med. Clin. North Am. 32 (2): 277–92. doi:10.1016/j.emc.2013.12.001. PMID 24766932.
- ↑ Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D'Agostino RB (1994). "Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons". N. Engl. J. Med. 331 (19): 1249–52. doi:10.1056/NEJM199411103311901. PMID 7935681.
- ↑ Chen Q, Yan Y, Zhang L, Cheng K, Liu Y, Zhu W (2014). "Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation". Cardiology. 127 (3): 176–82. doi:10.1159/000356954. PMID 24434544.
- ↑ Siu CW, Yeung CY, Lau CP, Kung AW, Tse HF (2007). "Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism". Heart. 93 (4): 483–7. doi:10.1136/hrt.2006.100628. PMC 1861478. PMID 17005710.
- ↑ Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S (2017). "Thyroid hormones and cardiovascular disease". Nat Rev Cardiol. 14 (1): 39–55. doi:10.1038/nrcardio.2016.174. PMID 27811932.
- ↑ Vijayakumar A, Ashwath G, Thimmappa D (2014). "Thyrotoxic periodic paralysis: clinical challenges". J Thyroid Res. 2014: 649502. doi:10.1155/2014/649502. PMC 3945080. PMID 24695373.