The Influence of Subclinical Hyperthyroidism on Blood Pressure, Heart Rate Variability, and Prevalence of Arrhythmias
Abstract
BACKGROUND: The impact of subclinical hyperthyroidism (sHT) on the cardiovascular system still needs to be elucidated. The aim of the study was to prospectively assess blood pressure (BP), variability in heart rate, and the prevalence of arrhythmias in patients with sHT, both before and after they are restored to the euthyroid state. METHODS: The study group consisted of 44 normotensive patients (37 women, 7 men), aged 22-65 years (mean±SD: 45.9±11.0) with sHT. Enrolled patients were drawn from 1080 patients referred to our department for treatment of hyperthyroidism. Study patients were treated with radioiodine treatment to restore the euthyroid state. Ambulatory BP monitoring and Holter electrocardiography were performed (i) when sHT was diagnosed and (ii) at least 6 months after they became euthyroid. RESULTS: sHT in comparison to the euthyroid state was associated with higher (109.3±7.1 vs. 107.1±7.7 mmHg) nocturnal systolic mean BP (p=0.035) and BP load (14.8 vs. 10.2%, p=0.033), mean diastolic BP (66.4±6.6 vs. 64.8±6.6 mmHg, p=0.047), and mean arterial pressure (80.8±43.1 vs. 79.3±43.6 mmHg, p=0.049). Moreover, significant changes in both the time and frequency domain measures of heart rate variability (HRV) were observed: decrease of the square root of the mean squared differences of successive NN intervals (rMSSD) (45.68±34.1 vs. 65.09±50.6 ms, p=0.03) and the low frequency power (LF) (5.71±0.99 vs. 6.0±1.01 ms(2), p=0.049) as well as increase of QT interval dispersion (58.25±28.5 vs. 46.90±12.1 ms, p=0.020). This was accompanied by a clinically insignificant increase in the frequency of ventricular extrasystoles (VES) (3.1±7.4 vs. 0.6±1.2 per hour, p=0.048) and increased mean heart rate (78.4±6.8 vs. 76.0±8.0 beats/min, p=0.004). Some of the parameters correlated positively with thyroid hormones: nocturnal diastolic BP with free triiodothyronine (FT(3)) (r=0.397, p=0.008), rMSSD with free thyroxine (FT(4)) (r=0.389, p=0.013), and QT interval dispersion with FT(4) (r=0.450, p=0.004). CONCLUSIONS: The study suggests that sHT in comparison to euthyroid status may be associated with a statistically significant but probably clinically insignificant increase of QT interval dispersion, prevalence of VES, elevated nocturnal arterial BP, and changes in HRV. These findings broaden our understanding of the cardiovascular effects of sHT.
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The evidence rests only with small uncontrolled studies that have shown improvements in cardiac structure and function, heart rate and the frequency of premature atrial and ventricular beats, bone mineral density, and muscle strength.
“Thus, the evidence rests only with small uncontrolled studies that have shown improvements in cardiac structure and function, heart rate and the frequency of premature atrial and ventricular beats, bone mineral density, and muscle strength (393)(394)(395)(396)405,(414)(415)(416)(417)426).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [405]
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- Authors
- Kaminski, G., Makowski, K., Michałkiewicz, D., Kowal, J., Ruchala, M., Szczepanek, E., & Gielerak, G.
- Affiliations
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland.
- Wojskowy Instytut Medyczny (PL)
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
- Poznan University of Medical Sciences (PL)
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2012-05
- Volume
- 22
- Issue
- 5
- Pages
- 454-460
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2078003355
- Cited by
- 61
- References
- 25
- Citations by year
- 2024: 3 · 2023: 6 · 2022: 11 · 2021: 3 · 2020: 8 · 2019: 8 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 3
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- subclinical hyperthyroidism, blood pressure, heart rate variability, cardiac arrhythmias, radioiodine therapy, euthyroidism, ambulatory blood pressure monitoring, Holter electrocardiography, QT dispersion, nocturnal blood pressure, RMSSD, low-frequency power, cardiovascular risk, antithyroid drugs, antihypertensive drugs
- MeSH terms
- Adult, Aged, Arrhythmias, Cardiac, Blood Pressure, Diastole, Female, Heart Rate, Humans, Hyperthyroidism, Iodine Radioisotopes, Male, Middle Aged, Thyroid Gland, Thyrotropin, Time Factors, Triiodothyronine, Electrocardiography, Ambulatory, Prevalence, Blood Pressure Monitoring, Ambulatory
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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