Heart in Hyperthyroidism
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Hyperthyroidism is a common endocrine disorder that produces important clinical consequences on the cardiovascular system. In overt hyperthyroidism the increase in left ventricular performance is predominantly sustained by an increased preload with enhanced left ventricular diastolic function and reduced systemic vascular resistance. The pattern of cardiovascular abnormalities is similar in subclinical and overt hypothyroidism, suggesting that a lesser degree of thyroid hormone deficiency may also affect the cardiovascular system. Untreated overt and subclinical hypothyroidism can lead to an increased risk of coronary heart disease (CHD), heart failure (HF), and cardiovascular mortality.
Prompt and effective recognition of cardiac manifestations of hyperthyroidism is crucial as cardiovascular complications account for most of the deaths in hyperthyroid patients. Graves’ disease should be considered in patients with pulmonary hypertension, dilated cardiomyopathy, and peripartum cardiomyopathy of unknown etiology.
Doppler echocardiography is a useful technique to assess cardiovascular complications in hyperthyroid patients with cardiac symptoms. Its use is justified in symptomatic patients as it allows assessment of potential cardiovascular involvement.
Correction of overt and subclinical hyperthyroidism should be the first step in improving the prognosis of hyperthyroid patients with cardiovascular complications.
The etiology of hyperthyroidism must be established to enable correct treatment of the disease and of the related cardiovascular complications.
KeywordsSubclinical hyperthyroidism Overt hyperthyroidism Cardiovascular risk Management Antithyroid drugs Radioactive iodine Surgery
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