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A Prospective Study on Cardiovascular Dysfunction in Patients with Hyperthyroidism and Its Reversal After Surgical Cure

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Abstract

Background

Cardiovascular dysfunction (CVD) is a major cause of mortality and morbidity in hyperthyroidism. CVD and its reversibility after total thyroidectomy (TT) are not adequately addressed. This prospective case–control study evaluates the effect of hyperthyroidism on myocardium and its reversibility after TT.

Materials and methods

Surgical candidates of new onset hyperthyroidism, Group A (n = 41, age < 60 years) was evaluated with 2D Echocardiography, serum n-terminal probrain natriuretic peptide (NT-proBNP) at the time of diagnosis (Point A), after achieving euthyroidism (Point B) with antithyroid drugs, and 3 months after TT (Point C). 20 patients with nontoxic benign thyroid nodules undergoing TT served as controls (Group B).

Results

Both groups were age and sex matched. Group A (n = 41) comprises Graves disease (n = 22) and Toxic Multinodular goiter (n = 19). At point A, CVD was evident in 26/41(63.4 %), pulmonary hypertension (PHT) in 24/41(58.5 %)—mild in 17/41(41.4 %) and moderate in 7/41(17 %)—dilated cardiomyopathy (DCM) in 8/41(19.5 %), heart failure in 4/41(9.7 %), and NT-proBNP elevated in 28/41(68.3 %). At point B, recovery was observed in PHT 19/26(73.1 %), DCM 4/8(50 %), heart failure 4/4(100 %), NT-proBNP in 3/28(10.7 %). At Point C, further improvement occurred in PHT 23/24(95.8 %), DCM 7/8(87.5 %), heart failure 4/4(100 %), and NT-proBNP in 24/28(85.7 %).

Conclusion

Pulmonary hypertension is completely reversible at 3 months after TT and is the most common cardiac event in Hyperthyroidism. Various parameters of CVD improved consistently after surgical cure. NT-proBNP levels correlated well with the severity and duration of CVD and hence can be an objective tool in monitoring of hyperthyroid cardiac dysfunction.

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Acknowledgments

We would like to thank Dr. Ravi, MD, DM, HOD of department of cardiology, and Dr. Gomathi, MD cardiologist, RGGGH and MMC, Chennai, for their valuable guidance in assessing the various echographic parameters. We would like to acknowledge Dr. Srinivasa Raman, MD, Director, Anderson Diagnostic services, for his excellent lab supports.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Madras Medical College, Chennai, India

    Sankaran Muthukumar, Dhalapathy Sadacharan, Krishnan Ravikumar, Gajarajan Mohanapriya, Zahir Hussain & R. V. Suresh

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  1. Sankaran Muthukumar
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  2. Dhalapathy Sadacharan
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  3. Krishnan Ravikumar
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  4. Gajarajan Mohanapriya
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  5. Zahir Hussain
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  6. R. V. Suresh
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Correspondence to Sankaran Muthukumar.

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Muthukumar, S., Sadacharan, D., Ravikumar, K. et al. A Prospective Study on Cardiovascular Dysfunction in Patients with Hyperthyroidism and Its Reversal After Surgical Cure. World J Surg 40, 622–628 (2016). https://doi.org/10.1007/s00268-015-3352-6

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  • DOI: https://doi.org/10.1007/s00268-015-3352-6

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