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Subclinical hyperthyroidism as a risk factor for atrial fibrillation
Abstract
Objectives Atrial fibrillation is a well-known manifestation of hyperthyroidism. We studied whether subclinical hyperthyroidism with low serum thyrotropin concentrations and free thyroid hormone concentrations within the normal range in clinically euthyroid persons is a risk factor for subsequent atrial fibrillation.Methods We studied 23,638 persons. The subjects were classified according to their serum thyrotropin concentrations: group 1 comprised those with normal values of serum thyrotropin concentration (>0.4-5.0 mU/L) and free tri-iodothyronine and free thyroxine concentrations were within the normal range (22,300 subjects), group 2 comprised those with both low serum thyrotropin values (</=0.03 mU/L) and elevated free tri-iodothyronine and free thyroxine concentrations (725 subjects), and group 3 comprised those with low values of serum thyrotropin (<0.4 mU/L) and free triiodothyronine and free thyroxine concentrations were within the normal range (613 subjects).Results Atrial fibrillation was present in 513 persons (2.3%) in group 1 with normal values for serum thyrotropin, 100 (13.8%) in group 2 with overt hyperthyroidism, and 78 (12.7%) in group 3 with subclinical hyperthyroidism. The prevalence of atrial fibrillation in patients with low serum thyrotropin concentrations (<0.4 mU/L) was 13.3% compared with 2.3% in patients with normal values for serum thyrotropin (P <.01). The relative risk of atrial fibrillation in subjects with low serum thyrotropin and normal free tri-iodothyronine and free thyroxine concentrations, compared with those with normal concentrations of serum thyrotropin, was 5.2 (95% CI 2.1-8.7, P <.01).Conclusion A low serum thyrotropin concentration is associated with a >5-fold higher likelihood for the presence of atrial fibrillation with no significant difference between subclinical and overt hyperthyroidism.
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“Cardiovascular morbidity and mortality are particularly increased in men, in elderly patients with high-normal FT 4 levels and in patients with underlying heart disease [71-73, 76, 77, 87, 91, 92, 94] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [72]
In the citing paper
“A greater risk of AF was also documented in individuals with serum TSH <0.1 mIU/l and underlying heart disease [72] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [72]
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 [25]
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 [98]
In the citing paper
“>5-fold higher likelihood for the presence of atrial fibrillation in both patients with subclinical and overt hyperthyroidism (98).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [98]
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Metadata
- Authors
- Auer, J., Scheibner, P., Mische, T., Langsteger, W., Eber, O., & Eber, B.
- Affiliations
- Klinikum Wels-Grieskirchen (AT)
- ORCID
- Auer, Johann
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2001-11
- Volume
- 142
- Issue
- 5
- Pages
- 838-842
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2040416944
- Cited by
- 314
- References
- 50
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 4 · 2023: 8 · 2022: 14 · 2021: 10 · 2020: 8 · 2019: 14 · 2018: 12 · 2017: 11 · 2016: 11 · 2015: 14 · 2014: 12 · 2013: 25 · 2012: 16
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- 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
- subclinical hyperthyroidism, atrial fibrillation, serum thyrotropin, free triiodothyronine, free thyroxine, overt hyperthyroidism, risk factors, thyroid function
- MeSH terms
- Atrial Fibrillation, Humans, Hyperthyroidism, Middle Aged, Risk Factors, Thyrotropin, Thyroxine, Triiodothyronine, Comorbidity
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