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Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism
  1. Chung-Wah Siu,
  2. Chun-Yip Yeung,
  3. Chu-Pak Lau,
  4. Annie W C Kung,
  5. Hung-Fat Tse
  1. Cardiology Division, Department of Medicine and Metabolic and Endocrinology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
  1. Correspondence to:
    Professor H-F Tse or Professor AWC Kung
    Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China; hftse{at}hkucc.hku.hk or awckung{at}hkucc.hku.hk

Abstract

Background: There are limited systematic data on the incidence, clinical characteristics and outcomes of congestive heart failure (CHF) in patients with hyperthyroidism. The aim of this study was to investigate the incidence, clinical characteristics and outcome of CHF as the initial presentation in patients with primary hyperthyroidism.

Methods: The prevalence, clinical characteristics and outcome of CHF was studied in 591 consecutive patients (mean (SD) age 45 (1) years, 140 men) who presented with primary hyperthyroidism.

Results: CHF was the presenting condition in 34 patients (5.8%) with hyperthyroidism. The presence of atrial fibrillation at presentation (OR 37.4, 95% CI 9.72 to 144.0, p<0.001) was an independent predictor for the occurrence of CHF. Of the 34 patients with CHF, 16 (47%) had systolic left ventricular dysfunction with left ventricular ejection fraction (LVEF)<50%. They were predominantly male (OR 26.6, 95% CI 2.6 to 272.5, p = 0.006) and had a lower serum thyroxine level (OR 0.93, 95% CI 0.87 to 0.99, p = 0.044) than patients with preserved left ventricular systolic function. In these patients, LVEF (55 (4)% vs 30 (2)%, p<0.001) and New York Heart Association functional class (1.2 (0.1) vs 2.5 (0.2), p<0.001) improved significantly 3 months after achieving euthyroid status. Systolic left ventricular dysfunction (mean (SD) LVEF 38 (4)%) persisted on long-term follow-up in five patients: no clinical parameter could be identified to predict the occurrence of this persistent cardiomyopathy (p>0.05).

Conclusion: CHF was the initial clinical presentation in approximately 6% of patients with hyperthyroidism, and half of them had left ventricular systolic dysfunction. Symptoms of CHF subsided and LVEF improved after treatment for hyperthyroidism. Nonetheless, one-third of these patients developed persistent dilated cardiomyopathy.

  • CHF, congestive heart failure
  • LVEF, left ventricular ejection fraction
  • NYHA, New York Heart Association

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Footnotes

  • Published Online First 27 September 2006

  • Competing interests: None.

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