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Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Open accessAbstract
BACKGROUND: Low serum thyrotropin concentrations are a sensitive indicator of hyperthyroidism but can also occur in persons who have no clinical manifestations of the disorder. We studied whether low serum thyrotropin concentrations in clinically euthyroid older persons are a risk factor for subsequent atrial fibrillation. METHODS: We studied 2007 persons (814 men and 1193 women) 60 years of age or older who did not have atrial fibrillation in order to determine the frequency of this arrhythmia during a 10-year follow-up period. The subjects were classified according to their serum thyrotropin concentrations: those with low values (< or = 0.1 mU per liter; 61 subjects); those with slightly low values (> 0.1 to 0.4 mU per liter; 187 subjects); those with normal values (> 0.4 to 5.0 mU per liter; 1576 subjects); and those with high values (> 5.0 mU per liter; 183 subjects). RESULTS: During the 10-year follow-up period, atrial fibrillation occurred in 13 persons with low initial values for serum thyrotropin, 23 with slightly low values, 133 with normal values, and 23 with high values. The cumulative incidence of atrial fibrillation at 10 years was 28 percent among the subjects with low serum thyrotropin values (< or = 0.1 mU per liter), as compared with 11 percent among those with normal values; the age-adjusted incidence of atrial fibrillation was 28 per 1000 person-years among those with low values and 10 per 1000 person-years among those with normal values (P = 0.005). After adjustment for other known risk factors, the relative risk of atrial fibrillation in elderly subjects with low serum thyrotropin concentrations, as compared with those with normal concentrations, was 3.1 (95 percent confidence interval, 1.7 to 5.5; P < 0.001). The 10-year incidence of atrial fibrillation in the groups with slightly low and high serum thyrotropin values was not significantly different from that in the group with normal values. CONCLUSIONS: Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.
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In the citing paper
“Cardiovascular symptoms are the most frequent indicators of mild thyroid hormone excess in the elderly, similar to overt hyperthyroidism [52,53] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [52]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“An increased incidence of AF has also been observed in elderly persons with low serum TSH (0.1-0.5 mIU/l) with an HR of 1.6 (95% CI: 1.0-2.5)[52] and 1.85 (95% CI: 1.14-3.00)[53] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [52]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A 2-to 3-fold increased risk of atrial fibrillation (AF) was associated with SHyper in elderly subjects in two large prospective studies [52,53] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [52]
The cited source says what the claim attributes to it.
In the citing paper
“Excess thyroid hormone can also increase the risk of arrhythmias24 25 and muscle weakness23 in older people, which can contribute to a greater risk of falls.”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [24]
The cited source says what the claim attributes to it.
In the citing paper
“lower serum TSH levels are associated with increased risk of atrial fibrillation (AF) (60)”
From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [60]
In the citing paper
“Older patients with low TSH and higher fT4 have a higher prevalence and incidence of atrial fibrillation compared with euthyroid subjects (94–98)”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [97]
In the citing paper
“Twenty years ago, a low serum TSH level was first associated with an increased risk of atrial fibrillation (AF) (12)”
From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [12]
In the citing paper
“in cohort studies, subclinical hyperthyroidism or lower serum TSH have been associated with many involutional disease states including dementia, osteoporosis, AF, muscle weakness, low bone density, and fracture (12–14, 18, 20, 48, 49).”
From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [12]
In the citing paper
“In contrast with subclinical hypothyroidism, many previous studies have shown that low serum TSH is associated with poor outcomes, either increased all-cause or vascular mortality, or AF (12–14, 17, 29, 36, 37).”
From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [12]
In the citing paper
“Sawin et al. (399) first reported a 2.8-fold increased risk of atrial fibrillation in SH subjects over age 60 years in 1994, and subsequent studies have confirmed that the risk of arrhythmias, particularly atrial fibrillation, is increased in SH (381,384,388,391,400,401).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [399]
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Citations
Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1958) · Journal of the American Statistical Association · doi:10.1080/01621459.1958.10501452 · Cited by 39,158
Epidemiologic Features of Chronic Atrial Fibrillation
Kannel, W. B., Abbott, R. D., Savage, D. D., & McNamara, P. M. (1982) · New England Journal of Medicine · doi:10.1056/nejm198204293061703 · Cited by 2,304
The Statistical Analysis of Failure Time Data
Klein, J. P., Kalbfleisch, J. D., & Prentice, R. L. (1982) · Technometrics · doi:10.1080/00401706.1982.10487769 · Cited by 2,248
Atrial Fibrillation: A Major Contributor to Stroke in the Elderly: The Framingham Study
Wolf, P. A. (1987) · Archives of Internal Medicine · doi:10.1001/archinte.1987.00370090041008 · Cited by 1,108
Fade, J. V., Franklyn, J. A., Cross, K. W., Jones, S. C., & Sheppard, M. C. (1991) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1991.tb01739.x · Cited by 567
Duration of atrial fibrillation and imminence of stroke: the Framingham study.
Wolf, P. A., Kannel, W. B., McGee, D., Meeks, S. L., Bharucha, N. E., & Pm, M. (1983) · Stroke · doi:10.1161/01.str.14.5.664 · Cited by 336
Thyroid Dysfunction in Adults Over Age 55 Years
Bagchi, N. (1990) · Archives of Internal Medicine · doi:10.1001/archinte.150.4.785 · Cited by 275
Arterial embolism in thyrotoxicosis with atrial fibrillation.
Staffurth, J., Gibberd, M. C., & Fui, S. N. T. (1977) · BMJ · doi:10.1136/bmj.2.6088.688 · Cited by 181
Stroke in thyrotoxicosis with atrial fibrillation.
Petersen, P., & Hansen, J. M. (1988) · Stroke · doi:10.1161/01.str.19.1.15 · Cited by 178
Research works printed but not linked: 5
- 10.1001/archinte.147.9.1561 · DOI · Paper page
- Furszyfer J, 1970, Mayo Clin Proc, 45, 636
- 10.1001/archinte.151.3.549 · DOI
- 10.2307/2281868 · DOI · Paper page
- Sandler G, 1959, Q J Med, 52, 347
Cited by
Sorted by citations
Items 201–300 of 1,001
Petretta, M., Bonaduce, D., Spinelli, L., Vicario, M., Nuzzo, V., Marcianò, F., Camuso, P., Sanctis, V. D., & Lupoli, G. (2001) · European Journal of Endocrinology · doi:10.1530/eje.0.1450691 · Cited by 111
“It has been demonstrated that endogenous subclinical hyperthyroidism has a significant clinical impact and that it affects cardiac morphology and function ( 29 , 30).”
BackgroundKerr, C. R., Boone, J. A., Connolly, S. J., Greene, M., Klein, G. J., Sheldon, R. S., & Talajic, M. R. (1996) · European Heart Journal · doi:10.1093/eurheartj/17.suppl_c.48 · Cited by 108
Åsvold, B. O., Bjøro, T., Platou, C., & Vatten, L. J. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2012.04477.x · Cited by 107
Sakorafas, G. H., Sampanis, D., & Safioleas, M. C. (2009) · Surgical Oncology · doi:10.1016/j.suronc.2009.04.002 · Cited by 107
“Chronic TSH suppression may be associated with some morbidity, such as bone loss (particularly in postmenopausal women), cardiac effects (mainly atrial fibrillation, particularly in older patients), etc [119,120].”
BackgroundSubclinical Thyroid Dysfunction
Woeber, K. A. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440310023002 · Cited by 107
Thyroid nodules - Stepwise diagnosis and management
Pοlyzos, S. A., Kita, M. D., & Avramidis, A. (2007) · HORMONES · doi:10.14310/horm.2002.111107 · Cited by 106
Haemodynamic changes following treatment of subclinical and overt hyperthyroidism
Faber, J., Wiinberg, N., Schifter, S., & Mehlsen, J. (2001) · European Journal of Endocrinology · doi:10.1530/eje.0.1450391 · Cited by 104
Hyperthyroidism and the Management of Atrial Fibrillation
SHIMIZU, T., Koide, S., Noh, J. Y., Sugino, K., Ito, K., & Nakazawa, H. K. (2002) · Thyroid · doi:10.1089/105072502760143863 · Cited by 104
“The overall therapeutic approach will be applied to patients of subclinical hyperthyroidism (25,26) that was incidentally diagnosed because of the presence of atrial fibrillation.”
Complex relationship between free thyroxine and TSH in the regulation of thyroid function
Hoermann, R., Eckl, W., Hoermann, C., & Larisch, R. (2010) · European Journal of Endocrinology · doi:10.1530/eje-10-0106 · Cited by 101
Görenek, B., Pelliccia, A., Benjamin, E. J., Boriani, G., Crijns, H. J. G. M., Fogel, R. I., Gelder, I. C. V., Halle, M., Kudaiberdieva, G., Lane, D. A., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316676037 · Cited by 104
“15) Sawin et al.(255) Framingham Heart study Cohort 2007 10 yrs Euthyroid 8.”
Population screening for autoimmune thyroid disease.
Tunbridge, W. M., & Vanderpump, M. (2000) · Endocrinology and metabolism clinics of North America (Print) · doi:10.1016/s0889-8529(05)70129-8 · Cited by 101
Monzani, A., Prodam, F., Rapa, A., Moia, S., Agarla, V., Bellone, S., & Bona, G. (2012) · European Journal of Endocrinology · doi:10.1530/eje-12-0656 · Cited by 101
Goichot, B., Caron, P., Landron, F., & Bouée, S. (2015) · Clinical Endocrinology · doi:10.1111/cen.12816 · Cited by 101
Natural history, diagnosis and management of subclinical thyroid dysfunction
Biondi, B. (2012) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2011.12.004 · Cited by 98
Hypothyroidisim following hemithyroidectomy: Incidence, risk factors, and management
McHenry, C. R., & Slusarczyk, S. J. (2000) · Surgery · doi:10.1067/msy.2000.110242 · Cited by 99
Effraimidis, G., Strieder, T. G. A., Tijssen, J. G. P., & Wiersinga, W. M. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-0785 · Cited by 99
Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers
Jonklaas, J., & Razvi, S. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30371-1 · Cited by 100
Stavrakis, S., Yu, X., Patterson, E. S., Huang, S., Hamlett, S., Chalmers, L. J., Pappy, R. M., Cunningham, M. W., MORSHED, S. A., Davies, T. F., et al. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.07.015 · Cited by 98
Peeters, R. P. (2008) · Hormones · doi:10.14310/horm.2002.1111035 · Cited by 98
“45 mU/L,(44,45,50) while in a substantial proportion of elderly patients TSH values normalize.(49,51,52) Before considering treatment of patients with a suppressed TSH, other causes should be excluded.”
BackgroundAdequacy of thyroid hormone replacement in a general population
Okosieme, O. E., Belludi, G., Spittle, K., Kadiyala, R., & Richards, J. (2011) · QJM · doi:10.1093/qjmed/hcq222 · Cited by 96
“Uncorrected hypothyroidism is associated with adverse effects on body weight,5 lipid profile6 and blood pressure7 while thyroid hormone excess has been shown to increase the risks of atrial fibrillation,8,9 osteoporosis10,11 and fractures.9 In a cohort of older adults including patients taking levothyroxine, Sawin et…”
BackgroundInfluentialApproach to the Patient with Nontoxic Multinodular Goiter
Bahn, R. S., & Castro, M. R. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2583 · Cited by 96
Mammen, J. S., McGready, J., Oxman, R., Chia, C. W., Ladenson, P. W., & Simonsick, E. M. (2015) · Thyroid · doi:10.1089/thy.2015.0180 · Cited by 94
“This increased risk of atrial fibrillation appears to be similar when thyrotoxicosis stems from overtreatment with thyroid hormone supplementation (22).”
BackgroundCappola, A. R., Desai, A. S., Medici, M., Cooper, L. S., Egan, D., Sopko, G. S., Fishman, G. I., Goldman, S., Cooper, D. S., Mora, S., et al. (2019) · Thyroid · doi:10.1089/thy.2018.0416 · Cited by 95
“3-fold increase in atrial fibrillation risk (53).”
How Useful Is Thyroid Function Testing in Patients With Recent-Onset Atrial Fibrillation?
Krahn, A. D. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.1996.00440180083010 · Cited by 94
Cardiac Dysrhythmias and Thyroid Dysfunction - The Hidden Menace?
Osman, F., GAMMAGE, M. D., Sheppard, M. C., & Franklyn, J. A. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8217 · Cited by 94
“Between 10% and 15% of hyperthyroid patients develop AF (9); this incidence increases with age irrespective of whether there is associated heart disease.”
BackgroundInfluentialSerum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study
Pearce, S. H. S., Razvi, S., Yadegarfar, M. E., Martin-Ruiz, C., Kingston, A., Collerton, J., Visser, T. J., Kirkwood, T. B., & Jagger, C. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1935 · Cited by 91
“Twenty years ago, a low serum TSH level was first associated with an increased risk of atrial fibrillation (AF) (12), and this association has been reproduced many times since (13–16).”
BackgroundThe Thyroid in Mind: Cognitive Function and Low Thyrotropin in Older People
Gan, E. H., & Pearce, S. H. S. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-2284 · Cited by 93
Thyroid Function and Left Ventricular Structure and Function in the Framingham Heart Study
Pearce, E. N., Yang, Q., Benjamin, E. J., Aragam, J., & Vasan, R. S. (2010) · Thyroid · doi:10.1089/thy.2009.0272 · Cited by 92
“It has been shown clearly, however, that patients with both overt and subclinical hyperthyroidism are at increased risk for atrial fibrillation (10).”
Self-citationSubclinical Thyroid Disease: A Clinician's Perspective
Cooper, D. S. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-129-2-199807150-00016 · Cited by 110
“Helfand and Redfern cite epidemiologic data from the Framingham study associating subclinical hyperthyroidism and atrial fibrillation (8).”
Diagnosis and management of thyrotoxicosis
Vaidya, B., & Pearce, S. H. S. (2014) · BMJ · doi:10.1136/bmj.g5128 · Cited by 91
Cellular electrophysiology of atrial fibrillation
BOSCH, R. F. (2002) · Cardiovascular Research · doi:10.1016/s0008-6363(01)00529-6 · Cited by 89
Rosario, P. W. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2009.03696.x · Cited by 88
Perioperative Management of Thyroid Dysfunction
Palace, M. R. (2017) · Health Services Insights · doi:10.1177/1178632916689677 · Cited by 90
Cognitive and neuropsychiatric aspects of subclinical hypothyroidism: Significance in the elderly
Davis, J. D., Stern, R. A., & Flashman, L. A. (2003) · Current Psychiatry Reports · doi:10.1007/s11920-003-0073-6 · Cited by 89
Determinants of longterm outcome of radioiodine therapy of sporadic non‐toxic goitre
Moli, R. L., Wesche, M. F. T., Buul, M. M. C. T.-V., & Wiersinga, W. M. (1999) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1999.00734.x · Cited by 88
“Moreover, the induction of subclinical hyperthyroidism by prescribing thyroxine in TSH suppressive doses carries a risk for the development of atrial fibrillation in patients older than 60 years (Sawin et al., 1994) and bone loss, especially in postmenopausal women (Uzzan et al.”
BackgroundThyroid disease in the emergency department: A clinical and laboratory review
Pimentel, L., & Hansen, K. N. (2005) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2004.08.020 · Cited by 87
Kerr, C. R., Boone, J. A., Connolly, S. J., Dorian, P., Green, M. S., Klein, G. J., Newman, D. M., Sheldon, R. S., & Talajic, M. R. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00589-x · Cited by 87
Hyperthyroidism in elderly hospitalised patients: Clinical features and treatment outcomes
Martin, F. I. R., & Deam, D. R. (1996) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1996.tb94135.x · Cited by 87
Are Bioequivalence Studies of Levothyroxine Sodium Formulations in Euthyroid Volunteers Reliable?
Blakesley, V., Awni, W., Locke, C., Ludden, T., Granneman, G. R., & Braverman, L. E. (2004) · Thyroid · doi:10.1089/105072504773297867 · Cited by 85
“On the other hand, mild thyrotoxicosis increases the likelihood of arrhythmias, ventricular dysfunction, reduced exercise performance, and possible cardiovascular death (5,15,16).”
Radioiodine therapy of thyroid autonomy
Reiners, C., & Schneider, P. (2002) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-002-0910-6 · Cited by 85
“In a prospective study in 2,007 persons over a 10-year follow-up period, Sawin et al. [ 25 ] showed that the cumulative incidence of atrial fibrillation at 10 years was 28% among subjects with low serum thyrotropin values (≤0.1 mU/l) as compared to 11% among those with normal values.”
BackgroundInfluentialCarswell, J. M., Gordon, J. H., Popovsky, E., Hale, A., & Brown, R. S. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-3125 · Cited by 83
“If our thesis is correct, however, our results may have important implications for severely hypothyroid patients of all ages particularly those in whom precise titration of the serum TSH concentration is required, such as individuals with thyroid carcinoma after thyroid ablation (38, 39) and the elderly (11).”
Shargorodsky, M., Serov, S., Gavish, D., Leibovitz, E., Harpaz, D., & Zimlichman, R. (2006) · Thyroid · doi:10.1089/thy.2006.16.381 · Cited by 84
Approach to the Patient with Subclinical Hyperthyroidism
Cooper, D. S. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-2472 · Cited by 83
“(20) of individuals more than age 60 yr who were prospectively followed over a 10-yr period.”
BackgroundMortoglou, A., & Candiloros, H. (2004) · HORMONES · doi:10.14310/horm.2002.11120 · Cited by 82
“1. Hyperthyroid 172 44.7‐14.3 25.02‐4.62 64 48.4‐15.5 25.3‐2.93 (14-75) (17.3-42.7) (18-85) (17.2-31.4) 2. Eurthyroid 171 34.2‐11.9 32.73‐5.68 62 35.4‐13.6 37.12‐6.30 (11-73) (21.1-48.6) (13-68) (25.2-65.2) 3. Hypothyroid 201 46.5‐14.6 28.77‐5.77 38 51.9‐15.5 29.35‐4.63 ( 9-84 ) (16.1-51.5) (21-89) (22.1-45.8) 4. Hypo…”
InfluentialThyroid dysfunction in the elderly
Boelaert, K. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.30 · Cited by 84
Approach to and Treatment of Thyroid Disorders in the Elderly
Papaleontiou, M., & Haymart, M. R. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.013 · Cited by 82
Heijckmann, A. C., Huijberts, M. S., Geusens, P., Vries, J. D., Menheere, P. P. C. A., & Wolffenbuttel, B. H. R. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01933 · Cited by 81
“In addition to physical discomfort, loss of weight, atrial fibrillation and cardiac dysfunction (10, 11 ), the possible negative effects on bone mineral density (BMD) and bone remodeling resulting in osteopenia and loss of bone strength are an important issue (12).”
BackgroundRelation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study)
Kim, E.-J., Lyass, A., Wang, N., Massaro, J. M., Fox, C. S., Benjamin, E. J., & Magnani, J. W. (2014) · American Heart Journal · doi:10.1016/j.ahj.2013.10.012 · Cited by 80
Self-citationMulder, J. E. (1998) · Medical Clinics of North America · doi:10.1016/s0025-7125(05)70596-4 · Cited by 87
Ullmann, T. M., Papaleontiou, M., & Sosa, J. A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac646 · Cited by 85
Thyroid hormones and cardiac arrhythmias
Tribulová, N., Knezl, V., Shainberg, A., Seki, S., & Soukup, T. (2009) · Vascular Pharmacology · doi:10.1016/j.vph.2009.10.001 · Cited by 82
“A low serum TSH is generally a sensitive marker of thyroid hormone excess and has been reported to be associated with a 3-fold higher risk of developing AF (Auer et al., 2001; Sawin et al., 1994).”
Chen, D., Lin, C., Chen, Y., & Chen, H. (2016) · PLoS ONE · doi:10.1371/journal.pone.0165601 · Cited by 80
Subclinical thyroid dysfunction and cardiovascular consequences: An alarming wake-up call?
Manolis, A. S., Manolis, T. A., Melita, H., & Manolis, A. S. (2019) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2019.02.011 · Cited by 81
Controversies in the Management of Low-Risk Differentiated Thyroid Cancer
Haymart, M. R., Esfandiari, N. H., Stang, M. T., & Sosa, J. A. (2017) · Endocrine Reviews · doi:10.1210/er.2017-00067 · Cited by 81
Vaidya, B., Williams, G. R., Abraham, P., & Pearce, S. H. S. (2007) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.03097.x · Cited by 78
Thyroid hormones and the cardiovascular system: Pathophysiology and interventions
Cini, G., Carpi, A., Mechanick, J. I., Cini, L., Camici, M., Galetta, F., Giardino, R., Russo, M. A., & Iervasi, G. (2009) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2009.08.003 · Cited by 80
Gharib, H., Tuttle, R. M., Baskin, H. J., Fish, L. H., SINGER, P. A., & McDermott, M. T. (2004) · Endocrine Practice · doi:10.4158/ep.10.6.497 · Cited by 79
Thyroid diseases in the elderly
Chiovato, L., Mariotti, S., & Pinchera, A. (1997) · Baillière s Clinical Endocrinology and Metabolism · doi:10.1016/s0950-351x(97)80272-8 · Cited by 77
Khan, R., Sikanderkhel, S., Gui, J., Adeniyi, A.-R., O’Dell, K., Erickson, M., Malpartida, J. C., Mufti, Z., Khan, T., Mufti, H., et al. (2020) · Cardiology Research · doi:10.14740/cr1034 · Cited by 80
Thyroid and Aging or the Aging Thyroid? An Evidence-Based Analysis of the Literature
Aggarwal, N., & Razvi, S. (2013) · Journal of Thyroid Research · doi:10.1155/2013/481287 · Cited by 80
“[40] C.”
BackgroundPerioperative evaluation and management of the patient with endocrine dysfunction
Schiff, R. L., & Welsh, G. A. (2003) · Medical Clinics of North America · doi:10.1016/s0025-7125(02)00150-5 · Cited by 75
Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Mazzaferri, E. L. (2007) · Yearbook of Endocrinology · doi:10.1016/s0084-3741(08)70096-9 · Cited by 75
Diagnosis and Management of Subclinical Hypothyroidism in Elderly Adults: A Review of the Literature
Hennessey, J. V., & Espaillat, R. (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13532 · Cited by 75
Evidence‐based Management of Toxic Multinodular Goiter (Plummer’s Disease)
Porterfield, J. R., Thompson, G. B., Farley, D. R., Grant, C. S., & Richards, M. L. (2008) · World Journal of Surgery · doi:10.1007/s00268-008-9566-0 · Cited by 75
“A prospective review of 2,007 patients found that 32% of patients age 60 years or older with a suppressed TSH will develop atrial fibrillation over a 10year period (level III) [ 5 ].”
BackgroundAssociations between subclinical thyroid disease and metabolic syndrome
Wang, C., Chang, T., & Chen, M.-F. (2012) · Endocrine Journal · doi:10.1507/endocrj.ej12-0076 · Cited by 75
Abonowara, A., Quraishi, A. U. R., Sapp, J. L., Alqambar, M. H., Saric, A., O’Connell, C. M., Rajaraman, M. M., Hart, R. D., & Imran, S. A. (2012) · Clinical and investigative medicine · doi:10.25011/cim.v35i3.16591 · Cited by 73
Recent Advances in Thyroid Cancer
Grubbs, E. G., Rich, T. A., Li, G., Sturgis, E. M., Younes, M. N., Myers, J. N., Edeiken‐Monroe, B. S., Fornage, B. D., Monroe, D. P., Staerkel, G., et al. (2008) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2007.12.010 · Cited by 74
Multinodular goitre: ‘much more to it than simply iodine deficiency’
Derwahl, M., & Studer, H. (2000) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1053/beem.2000.0104 · Cited by 74
Controversies in the follow-up and management of well-differentiated thyroid cancer.
Ringel, M. D., & Ladenson, P. W. (2004) · Endocrine Related Cancer · doi:10.1677/erc.0.0110097 · Cited by 73
“…from The Framingham Study that associated atrial fibrillation with serum TSH concentrations less than 0.1mU/l with mild elevations in thyroxine (Sawin et al. 1994), have led to concerns regarding the safety of thyroxine-suppression therapy in older patients and those with underlying cardiac…”
BackgroundBarbesino, G. (2018) · Gerontology · doi:10.1159/000490911 · Cited by 73
Marqusee, E., Haden, S. T., & Utiger, R. D. (1998) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70296-6 · Cited by 74
Hyperthyroidism and Cardiovascular Morbidity and Mortality
Osman, F., GAMMAGE, M. D., & Franklyn, J. A. (2002) · Thyroid · doi:10.1089/105072502760143854 · Cited by 74
“Between 10%–15% of hyperthyroid patients develop AF (13).”
InfluentialA 2013 Survey of Clinical Practice Patterns in the Management of Primary Hypothyroidism
Burch, H. B., Burman, K. D., Cooper, D. S., & Hennessey, J. V. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1046 · Cited by 73
“Because overtreatment with thyroid hormone is a frequent finding in patients intended for replacement therapy (20, 21), and the resultant subclinical thyrotoxicosis is linked to adverse consequences such as atrial fibrillation (22, 23) and osteoporosis (22), the tendency among survey respondents to treat mild subclini…”
BackgroundLow serum thyrotropin is associated with high plasma fibrinogen
Dörr, M., Robinson, D. M., Wallaschofski, H., Schwahn, C., John, U., Felix, S. B., & Völzke, H. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1786 · Cited by 73
Fatourechi, V. (2001) · Mayo Clinic Proceedings · doi:10.4065/76.4.413 · Cited by 70
Subclinical hypothyroidism in children: natural history and when to treat
Bona, G., Prodam, F., & Monzani, A. (2012) · Journal of Clinical Research in Pediatric Endocrinology · doi:10.4274/jcrpe.851 · Cited by 72
“On the other hand, the adverse effects of overtreatment, such as reduced bone mass (22,23) and heart rhythm disorders (24), should be likewise considered.”
BackgroundThyroxine replacement: a clinical endocrinologist’s viewpoint
Eligar, V, Taylor, P., Okosieme, O., Leese, G., & Dayan, C. (2016) · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · doi:10.1177/0004563216642255 · Cited by 72
Santoro, N. F., Braunstein, G. D., Butts, C. L., Martin, K. A., McDermott, M., & Pinkerton, J. V. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1271 · Cited by 75
Thyroid Hormone Use, Hyperthyroidism and Mortality in Older Women
Bauer, D. C., Rodondi, N., Stone, K. L., & Hillier, T. A. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.04.034 · Cited by 71
Using Body Mass Index to Predict Optimal Thyroid Dosing after Thyroidectomy
Ojomo, K. A., Schneider, D. F., Reiher, A. E., Lai, N. B., Schaefer, S. C., Chen, H., & Sippel, R. S. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2012.12.002 · Cited by 69
“21,37 Studies on primary hypothyroidism conclude that LT4 requirements decrease with age due to a slowing rate of thyroxine degradation.(3,13,38) A recent retrospective review compared male patients with pre- and postmenopausal women and found age-based differences could be accredited instead to changes in body weight…”
BackgroundSubclinical Thyroid Dysfunction and Cardiovascular Outcomes among Prospective Cohort Studies
Gencer, B., Collet, T., Virgini, V. S., Auer, R., & Rodondi, N. (2013) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530311313010003 · Cited by 70
Current Treatment Strategies in Metastasized Differentiated Thyroid Cancer
Kreissl, M. C., Janssen, M. J. R., & Nagarajah, J. (2018) · Journal of Nuclear Medicine · doi:10.2967/jnumed.117.190819 · Cited by 69
“However, long-term TSH suppression may increase the incidence or severity of cardiac arrhythmias and reduce bone density (13,14).”
BackgroundThe Prevention and Management of Iodine-Induced Hyperthyroidism and its Cardiac Features
Dunn, J. T., Semigran, M. J., & Delange, F. (1998) · Thyroid · doi:10.1089/thy.1998.8.101 · Cited by 69
Genetic and Environmental Influences on Thyroid Hormone Variation in Mexican Americans
Samollow, P. B., Perez, G. M., Kammerer, C. M., Finegold, D. N., Zwartjes, P. W., Havill, L. M., Comuzzie, A. G., Mahaney, M. C., Göring, H. H. H., Blangero, J., et al. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031706 · Cited by 69
“Interest in identifying genes and environmental factors that influence thyroid hormone function is increasing, especially given recent reports that subclinical alterations in thyroid hormone levels can have detrimental effects on cardiac function (8, 9, 12, 29, 30); alter serum lipoproteins, triglycerides, and other r…”
BackgroundSubclinical Thyroid Dysfunction and Cognitive Decline in Old Age
Wijsman, L. W., de Craen, A. J. M., Trompet, S., Gussekloo, J., Stott, D. J., Rodondi, N., Welsh, P., Jukema, J. W., Westendorp, R. G. J., & Mooijaart, S. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0059199 · Cited by 68
“Furthermore, it is well established that subclinical hyperthyroidism is related to an increased risk of atrial fibrillation [15,18,19], which is an important risk factor for stroke.”
BackgroundNódulos de tireóide e câncer diferenciado de tireóide: consenso brasileiro
Maia, A. L., Ward, L. S., de Carvalho, G. A., Graf, H., Maciel, R. M. B., Maciel, L. M. Z., Rosário, P. W., & Vaisman, M. (2007) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302007000500027 · Cited by 68
“Entretanto, os efeitos adversos sobre o sistema cardiovascular, causando a longo prazo o aumento da incidência de fibrilação auricular, e no sistema ósseo, promovendo osteoporose, principalmente em mulheres menopausadas, colocam sérias restrições ao seu uso (47-49).”
Subclinical Hypothyroidism and Cardiovascular Risk
Palmieri, E. A., Fazio, S., Lombardi, G., & Biondi, B. (2004) · Treatments in Endocrinology · doi:10.2165/00024677-200403040-00005 · Cited by 68
Disorders of the Equine Thyroid Gland
Breuhaus, B. A. (2011) · Veterinary Clinics of North America Equine Practice · doi:10.1016/j.cveq.2010.12.002 · Cited by 68
Subclinical Hyperthyroidism and Atrial Fibrillation
Sawin, C. T. (2002) · Thyroid · doi:10.1089/105072502760143881 · Cited by 68
“A 10-year follow-up of older patients with low serum TSH values showed that they had an almost threefold higher rate of atrial fibrillation than did those with a normal serum TSH value (24), a finding that supports the impression gained in a smaller previous study (25).”
Ceresini, G., Ceda, G. P., Lauretani, F., Maggio, M., Usberti, E., Marina, M., Bandinelli, S., Guralnik, J. M., Valenti, G., & Ferrucci, L. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12267 · Cited by 67
Ospina, N. S., & Papaleontiou, M. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.02.003 · Cited by 67
Tauchmanovà, L., Nuzzo, V., Del Puente, A., Fonderico, F., Esposito-Del Puente, A., Padulla, S., Rossi, A., Bifulco, G., Lupoli, G., & Lombardi, G. (2004) · Maturitas · doi:10.1016/j.maturitas.2004.02.017 · Cited by 66
“Although the frequency and exact biological effects of SH are still a matter of debate, different studies suggest greater incidence of cardiological abnormalities, including arrhythmia and increased left ventricular mass, in SH patients [5,6].”
BackgroundRisk of ischemic stroke after new-onset atrial fibrillation in patients with hyperthyroidism
Siu, C., Pong, V., Zhang, X., Chan, Y., Jim, M., Liu, S., Yiu, K., Kung, A. W. C., Lau, C., & Tse, H. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.10.023 · Cited by 63
Tigas, S. K., Idiculla, J. M., Beckett, G. J., & Toft, A. D. (2000) · Thyroid · doi:10.1089/thy.2000.10.1107 · Cited by 64
Sdano, M. T., Falciglia, M., Welge, J. A., & Steward, D. L. (2005) · Otolaryngology · doi:10.1016/j.otohns.2005.06.007 · Cited by 64
“Sawin and colleagues found a threefold higher risk of atrial fibrillation for those with a suppressed TSH level, with those over the age of 60 at highest risk.(26) A study of 60 middle-aged patients with subclinical thyrotoxicosis resulting from THST found an increase in supraventricular arrhythmias and left ventricul…”
BackgroundLindsay, R. S., & Toft, A. D. (1997) · The Lancet · doi:10.1016/s0140-6736(97)80050-5 · Cited by 62
Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism
Das, G., Ojewuyi, T. A., Baglioni, P., Geen, J., Premawardhana, L. D., & Okosieme, O. E. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2012.04345.x · Cited by 61
Ghianda, S. D., Tonacchera, M., & Vitti, P. (2013) · Climacteric · doi:10.3109/13697137.2013.838554 · Cited by 64
Suh, B., Shin, D. W., Park, Y., Lim, H., Yun, J. M., Song, S. O., Park, J., Cho, B., & Güallar, E. (2018) · European Journal of Endocrinology · doi:10.1530/eje-18-0551 · Cited by 61
Excess Triiodothyronine as a Risk Factor of Coronary Events
Peters, A., Ehlers, M., Blank, B., Exler, D., Falk, C., Kohlmann, T., Fruehwald‐Schultes, B., Wellhoener, P., Kerner, W., & Fehm, H. L. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.13.1993 · Cited by 61
Metadata
- Authors
- Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B.
- Affiliations
- Boston University (US)
- Veterans Health Administration (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1994-11-10
- Volume
- 331
- Issue
- 19
- Pages
- 1249-1252
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2335515807
- Cited by
- 1,259
- References
- 31
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 27 · 2023: 25 · 2022: 46 · 2021: 37 · 2020: 27 · 2019: 38 · 2018: 41 · 2017: 44 · 2016: 48 · 2015: 45 · 2014: 44 · 2013: 63 · 2012: 65
- FWCI
- 16.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc038038-022, 5r01hl040423-06)
- National Heart, Lung, and Blood Institute (R01-HL-40423-04, N01-HC-38038)
- National Institute of Neurological Disorders and Stroke (2-R01-NS-17950-12, R01NS017950)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- thyroid-stimulating hormone, subclinical hyperthyroidism, older adults, hyperthyroidism, arrhythmia risk, thyroid function, incidence, risk factors, euthyroid patients, parathyroid hormone, parathyroidectomy, parathyroid hormone replacement, hypoparathyroidism
- MeSH terms
- Age Factors, Aged, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Hyperthyroidism, Male, Middle Aged, Risk Factors, Thyrotropin, Thyroxine, Incidence, Confidence Intervals
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