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The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study
Open accessAbstract
OBJECTIVES: To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients. DESIGN: Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level. SETTING: Primary care patients in the city of Copenhagen. SUBJECTS: Registry data for 586,460 adults who had their thyroid function evaluated for the first time by their general practitioner during 2000-10 and who were without previously recorded thyroid disease or atrial fibrillation. MAIN OUTCOME MEASURE: Poisson regression models used to estimate risk of atrial fibrillation by thyroid function. RESULTS: Of the 586,460 individuals in the study population (mean (SD) age 50.2 (16.9) years, 39% men), 562,461 (96.0%) were euthyroid, 1670 (0.3%) had overt hypothyroidism, 12,087 (2.0%) had subclinical hypothyroidism, 3966 (0.7%) had overt hyperthyroidism, and 6276 (1.0%) had subclinical hyperthyroidism. Compared with the euthyroid individuals, the risk of atrial fibrillation increased with decreasing levels of thyroid stimulating hormone (TSH) from high normal euthyroidism (incidence rate ratio 1.12 (95% CI 1.03 to 1.21)) to subclinical hyperthyroidism with reduced TSH (1.16 (0.99 to 1.36)) and subclinical hyperthyroidism with supressed TSH (1.41 (1.25 to 1.59)). Both overt and subclinical hypothyroidism were associated with a lower risk of atrial fibrillation. CONCLUSION: The risk of atrial fibrillation was closely associated with thyroid activity, with a low risk in overt hypothyroidism, high risk in hyperthyroidism, and a TSH level dependent association with risk of atrial fibrillation across the spectrum of subclinical thyroid disease.
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“Recently, a TSH level-dependent association with the risk of AF was found across the whole spectrum of thyroid function in a large population-based cohort study [74] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [74]
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In the citing paper
“Compared to euthyroid individuals (TSH: 0.4-5 mIU/l), the risk of AF increased with decreasing levels of serum TSH from high-normal thyroid function [TSH: 0.2-0.4mIU/l; adjusted incidence rate ratio (IRR) = 1.12] to mild SHyper (TSH: 0.1-0.2mIU/l; IRR = 1.16) and grade 2 SHyper (TSH: <0.1 mIU/l; IRR = 1.41) [74] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [74]
In the citing paper
“Similar trends were seen for men.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [401]
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 [401]
In the citing paper
“However, absolute incidence rates of atrial fibrillation were much lower in younger subjects; for example, women under the age of 65 years had atrial fibrillation incidence rates of 2.3 events per 1000 personyears (relative risk of 1.89 compared to age-matched euthyroid women), while women 65 years and older had incidence rates of 22.7 per 1000 person-years (relative risk of 1.27 compared to age-”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [401]
In the citing paper
“In the largest study to date (586,460 people followed for a median of 5.5 years), the highest relative risk for atrial fibrillation occurred in younger subjects, possibly because other causes predominate with age, and in subjects with lower TSH levels (401).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [401]
In the citing paper
“Some of these studies re-ported increased risks of overall mortality in older subjects (380,429), cardiovascular events (391), heart failure (381), and atrial fibrillation in all subjects (401) or in older subjects (384), and vertebral fractures in older women (408).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [401]
In the citing paper
“Thyroid dysfunction 206, 207 hypothyroidism subclinical hyperthyroidism overt hyperthyroidism (reference: euthyroid) HR 1.23 (95% CI 0.77-1.97)RR 1.31 (95% CI 1.19-1.44)RR 1.42 (95% CI 1.22-1.63)”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [206]
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Citations
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Khaznadar, A. A. J., & Baban, Z. (2023) · Journal of Sulaimani Medical College · doi:10.17656/jsmc.10394
Hipertiroidismo e insuficiencia cardiaca
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Research Progress on Modifiable Risk Factors of Atrial Fibrillation
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Boulakh, L. (2024) · Acta Ophthalmologica · doi:10.1111/aos.16734
Large ovarian cystadenoma masked by obesity in a patient with graves' hyperthyroidism
Radić, N., Jeremić, D., Živanović, D., Dronjak, Đ., Dumanović, J., Lazarevski, D., & Šumarac-Dumanović, M. (2024) · Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma · doi:10.5937/mgiszm2494007r
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Özdoğru, D., & Erdem, M. (2025) · The European Research Journal · doi:10.18621/eurj.1618895
Ursem, S. R., Noordam, R., van den Berg, J. M., Boelen, A., Elders, P. J. M., den Elzen, W. P. J., & Heijboer, A. C. (2025) · Thyroid · doi:10.1177/10507256261449444
Clerc, J., Bodin-Cufi, P., Giraud, L., Forbes, A., Laroche, E., Groussin, L., Schubert, L., Mouraeff, Y., Hilmy, K., Cottereau, A., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14217871
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Ueda, A. (2026) · Korean Circulation Journal · doi:10.4070/kcj.2025.0510
Thyroid Hormone Excess in Sudden Death: A Clinicopathological Spectrum in an Autopsy Study
Hata, Y., Saito, Y., Hirono, K., Ichimata, S., & Nishida, N. (2026) · Hormone and Metabolic Research · doi:10.1055/a-2851-8963
Yang, Y., & Zhong, G. (2026) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-026-04093-x
Yu, C., Chen, Z. Y., & Zhu, Y. (2026) · Angiology · doi:10.1177/00033197261467578
Bjerkreim, B. A., Hammerstad, S. S., Lee-Ødegård, S., & Eriksen, E. F. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1919606
Labbé, V., Aïssaoui, N., Asfar, P., Bagate, F., Bourcier, S., Éderhy, S., Helms, J., Hraiech, S., Joffre, J., Joseph, A., et al. (2026) · Annals of Intensive Care · doi:10.1016/j.aicoj.2026.100159
Zhang, Y., Feng, X., Luo, Q., Zhao, J., Liu, F., Wang, H., & Zhang, L. (2026) · BMC Medical Imaging · doi:10.1186/s12880-026-02807-0
Decoding Atrial Fibrillation Heterogeneity
Yoshimura, H., Chung, S., Lip, G. Y. H., Schmidt, A. F., & Providencia, R. A. (2026) · JACC Advances · doi:10.1016/j.jacadv.2026.103352
Sapkota, S., Acharya, S., Bhandari, K., Parajuli, A., Baniya, A., Goranti, J., Abolbashari, M., & Soskin, B. (2026) · Clinical Medicine Insights Cardiology · doi:10.1177/11795468261500860
Metadata
- Authors
- Selmer, C., Olesen, J. B., Hansen, M. L., Lindhardsen, J., Olsen, A.-M. S., Madsen, J. C., Faber, J., Hansen, P. R., Pedersen, O. D., Torp-Pedersen, C., & Gislason, G. H.
- Affiliations
- Gentofte Hospital (DK)
- University of Copenhagen (DK)
- Roskilde Sygehus (DK)
- Corresponding author
- Selmer, C.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-11-27
- Volume
- 345
- Issue
- nov27 1
- Pages
- e7895-e7895
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3508199
- OpenAlex
- W2015178517
- Cited by
- 323
- References
- 43
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 22 · 2023: 43 · 2022: 21 · 2021: 21 · 2020: 33 · 2019: 25 · 2018: 28 · 2017: 21 · 2016: 21 · 2015: 20 · 2014: 23 · 2013: 14 · 2012: 1
- FWCI
- 14.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Funders
- Hjerteforeningen
- 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
- atrial fibrillation, thyroid dysfunction, thyroid-stimulating hormone, subclinical hyperthyroidism, overt hyperthyroidism, subclinical hypothyroidism, overt hypothyroidism, thyroid function, cardiovascular risk
- MeSH terms
- Atrial Fibrillation, Denmark, Female, Follow-Up Studies, Humans, Male, Middle Aged, Population Surveillance, Registries, Retrospective Studies, Risk Factors, Thyroid Diseases, Incidence
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