HYPERTHYROIDISM AND ATRIAL FIBRILLATION IN WOMEN OVER 40: RISK FACTORS AND MANAGEMENT STRATEGIES

Samandar Ostonov; Fayzi Nasullayev

Authors

Ostonov Samandar Deputy director of the Navoi region Branch of the Republican Emergency Medical Center. Author
Nasullayev Fayzi He is a student of the Department of Pediatrics of the Medical Faculty of Navoi State University Author

Keywords:

Hyperthyroidism, Atrial fibrillation, Thyrotoxic arrhythmia, Women cardiovascular health, Middle-aged women, Subclinical hyperthyroidism, CHA₂DS₂-VASc score, Thyroid hormone cardiac effects, Anticoagulation in hyperthyroidism, Graves’ disease and AF

Abstract

Hyperthyroidism, characterized by excessive thyroid hormone production, is a well-established risk factor for atrial fibrillation (AF), particularly in women over 40. This article reviews the pathophysiological mechanisms, epidemiological data, and evidence-based management approaches for AF in hyperthyroid patients, with a focus on middle-aged and older women. We analyze key studies and clinical guidelines to provide a comprehensive overview of this critical cardiovascular-endocrine interaction.

References

1. Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., Ross, D. S., Sosa, J. A., & Stan, M. N. (2011). Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid, 21(6), 593–646. https://doi.org/10.1089/thy.2010.0417

2. Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., & Wann, S. (2020). ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. Journal of the American College of Cardiology, 75(15), 1902–1923. https://doi.org/10.1016/j.jacc.2020.02.025

3. Frost, L., Vestergaard, P., & Mosekilde, L. (2004). Hyperthyroidism and risk of atrial fibrillation or flutter: A population-based study. Archives of Internal Medicine, 164(15), 1675–1678. https://doi.org/10.1001/archinte.164.15.1675

4. Gammage, M. D., Parle, J. V., Holder, R. L., Roberts, L. M., Hobbs, F. D. R., Wilson, S., Sheppard, M. C., & Franklyn, J. A. (2007). Association between serum free thyroxine concentration and atrial fibrillation. Archives of Internal Medicine, 167(9), 928–934. https://doi.org/10.1001/archinte.167.9.928

5. Hollowell, J. G., Staehling, N. W., Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., & Braverman, L. E. (2002). Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). The Journal of Clinical Endocrinology & Metabolism, 87(2), 489–499. https://doi.org/10.1210/jcem.87.2.8182

6. January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., Heidenreich, P. A., Murray, K. T., Shea, J. B., Tracy, C. M., & Yancy, C. W. (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Journal of the American College of Cardiology, 74(1), 104–132. https://doi.org/10.1016/j.jacc.2019.01.011

7. Klein, I., & Ojamaa, K. (2001). Thyroid hormone and the cardiovascular system. New England Journal of Medicine, 344(7), 501–509. https://doi.org/10.1056/NEJM200102153440707

8. Osman, F., Franklyn, J. A., & Gammage, M. D. (2007). Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy. Thyroid, 17(5), 483–487. https://doi.org/10.1089/thy.2006.0327

9. Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P. W., Benjamin, E. J., & D’Agostino, R. B. (1994). Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. New England Journal of Medicine, 331(19), 1249–1252. https://doi.org/10.1056/NEJM199411103311901

10. 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. (2012). The spectrum of thyroid disease and risk of new onset atrial fibrillation: A large population cohort study. BMJ, 345, e7895. https://doi.org/10.1136/bmj.e7895