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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

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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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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: Brandt, Frans
Green, Anders
Brix, Thomas H
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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A critical review and meta-analysis of the association between overt hyperthyroidism and mortality

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