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A critical review and meta-analysis of the association between overt hyperthyroidism and mortality

Brandt, Frans, Green, Anders, Hegedüs, Laszlo, Brix, Thomas H·2011·European Journal of Endocrinology
DOI 10.1530/eje-11-0299
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Abstract

Background: Overt hyperthyroidism has been associated with cardiac arrhythmias, hypercoagulopathy, stroke, and pulmonary embolism, all of which may increase mortality. Some, but not all, studies show an increased mortality in patients with hyperthyroidism. This inconsistency may be due to differences in study design, characteristics of participants, or confounders. In order to test whether hyperthyroidism influences mortality, we performed a critical review and statistical meta-analysis. Methods: Based on an electronic PubMed search, using the Medical Subject Heading words such as hyperthyroidism, thyrotoxicosis, and mortality or survival, case–control and cohort studies were selected and reviewed. Using meta-analysis, an overall relative risk (RR) of mortality was calculated. Results: Eight studies fulfilled the inclusion criteria, six of which showed an increased all-cause mortality; seven studies, including 31 138 patients and 4 00 000 person years at risk, allowed calculation of mortality in a meta-analysis. Based on this, the RR of overall mortality was 1.21 (95% confidence interval: 1.05–1.38). Analyses including studies considering setting, treatment, and control for co-morbidity did not significantly alter this finding. As the measured heterogeneity (I 2) ranges from 89.1 to 98.3%, which is much higher than the 50% generally viewed on as a threshold, the statistical heterogeneity is very pronounced in the included studies. Conclusion: In patients diagnosed with hyperthyroidism, mortality is increased by ∼20%. Future studies need to address the cause of hyperthyroidism, impact of type of therapy, time dependency, as well as the potential influence of confounding or genetic susceptibility before the question of causality can be answered.

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  • A meta-analysis of 7 studies and 31,138 subjects concluded that overt hyperthyroidism increased overall mortality by 13% and cardiovascular mortality by 21%.

    “In another paper, a meta-analysis involved 7 studies and 31,138 subjects concluded that the presence of overt hyperthyroidism increased overall mortality by 13% and the mortality for cardiovascular causes by 21% [48].”

    From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [48]

  • Overt hyperthyroidism increases overall mortality by 13%.

    “A meta-analysis involving 7 studies and 31,138 subjects actually concluded that the presence of overt hyperthyroidism increases overall mortality by 13% and the mortality for CV causes by 21% [12].”

    From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [12]

  • Overt hyperthyroidism increases mortality for cardiovascular causes by 21%.

    “A meta-analysis involving 7 studies and 31,138 subjects actually concluded that the presence of overt hyperthyroidism increases overall mortality by 13% and the mortality for CV causes by 21% [12].”

    From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [12]

  • Untreated hyperthyroidism is associated with increased cardiovascular morbidity and mortality.

    “Untreated hyperthyroidism is associated with increased CV morbidity and mortality (73).”

    From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [73]

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Related

Authors
Brandt, F., Green, A., Hegedüs, L., & Brix, T. H.
Affiliations
  • Odense University Hospital (DK)
  • University of Southern Denmark (DK)
Corresponding author
Brandt, Frans
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2011-10
Volume
165
Issue
4
Pages
491-497
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-11-0299
OpenAlex
W2163957464
Cited by
170
References
44
Citations by year
2026: 5 · 2025: 12 · 2024: 8 · 2023: 10 · 2022: 11 · 2021: 14 · 2020: 24 · 2019: 8 · 2018: 6 · 2017: 13 · 2016: 11 · 2015: 12 · 2014: 13 · 2013: 12 · 2012: 11
FWCI
1.60
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
overt hyperthyroidism, thyrotoxicosis, mortality, all-cause mortality, relative risk, cardiac arrhythmias, hypercoagulability, stroke, pulmonary embolism, heterogeneity of study results
MeSH terms
Cardiovascular Diseases, Humans, Hyperthyroidism, Cohort Studies, Case-Control Studies, Randomized Controlled Trials as Topic

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