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Volume 331:1249-1252 November 10, 1994 Number 19 Next

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ABSTRACT

Background Low serum thyrotropin concentrations are a sensitive indicator of hyperthyroidism but can also occur in persons who have no clinical manifestations of the disorder. We studied whether low serum thyrotropin concentrations in clinically euthyroid older persons are a risk factor for subsequent atrial fibrillation.

Methods We studied 2007 persons (814 men and 1193 women) 60 years of age or older who did not have atrial fibrillation in order to determine the frequency of this arrhythmia during a 10-year follow-up period. The subjects were classified according to their serum thyrotropin concentrations: those with low values ( 0.1 mU per liter; 61 subjects); those with slightly low values (>0.1 to 0.4 mU per liter; 187 subjects); those with normal values (>0.4 to 5.0 mU per liter; 1576 subjects); and those with high values (>5.0 mU per liter; 183 subjects).

Results During the 10-year follow-up period, atrial fibrillation occurred in 13 persons with low initial values for serum thyrotropin, 23 with slightly low values, 133 with normal values, and 23 with high values. The cumulative incidence of atrial fibrillation at 10 years was 28 percent among the subjects with low serum thyrotropin values ( 0.1 mU per liter), as compared with 11 percent among those with normal values; the age-adjusted incidence of atrial fibrillation was 28 per 1000 person-years among those with low values and 10 per 1000 person-years among those with normal values (P = 0.005). After adjustment for other known risk factors, the relative risk of atrial fibrillation in elderly subjects with low serum thyrotropin concentrations, as compared with those with normal concentrations, was 3.1 (95 percent confidence interval, 1.7 to 5.5; P<0.001). The 10-year incidence of atrial fibrillation in the groups with slightly low and high serum thyrotropin values was not significantly different from that in the group with normal values.

Conclusions Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.

Source Information

From the Medical and Medical Research Services, Boston Veterans Affairs Medical Center, Boston (C.T.S., A.G., E.B., P.B.); the Section of Preventive Medicine and Epidemiology, Evans Memorial Department of Clinical Research (P.A.W.), and the Departments of Neurology (P.A.W.), Mathematics (A.J.B., R.B.D.), and Medicine (C.T.S., E.J.B.), Boston University, Boston; and the Framingham Heart Study, Framingham, Mass. (P.A.W., P.W.F.W.).

Address reprint requests to Dr. Sawin at the Boston Veterans Affairs Medical Center, 150 S. Huntington Ave., Boston, MA 02130.

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• Klein, I., Danzi, S. (2007). Thyroid Disease and the Heart. Circulation 116: 1725-1735 [Abstract] [Full Text]  
• Cappola, A. R. (2007). Subclinical Thyroid Dysfunction and the Heart. J. Clin. Endocrinol. Metab. 92: 3404-3405 [Full Text]  
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• Volzke, H. (2007). Hyperthyroidism and Mortality. J Am Coll Cardiol 49: 2228-2229 [Full Text]  
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• Cooper, D. S. (2007). Approach to the Patient with Subclinical Hyperthyroidism. J. Clin. Endocrinol. Metab. 92: 3-9 [Abstract] [Full Text]  
• O'Donnell, M. J., Valens, N., Lansberg, M. G., Wijman, C. A.C. (2006). Thyroid replacement therapy and atrial fibrillation in acute ischemic stroke.. Neurology 67: 1714-1715 [Full Text]  
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• Biondi, B., Palmieri, E. A., Lombardi, G., Fazio, S. (2003). Subclinical Thyroid Dysfunction and the Heart. ANN INTERN MED 139: 866-867 [Full Text]  
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• Toft, A D, Beckett, G J (2003). Thyroid function tests and hypothyroidism: Authors' reply. BMJ 326: 1087-1087 [Full Text]  
• Crilly, M. (2003). Thyroid function tests and hypothyroidism: Reducing concentrations further would be harmful. BMJ 326: 1086-1086 [Full Text]  
• Vanderpump, M. P, Franklyn, J. A (2003). Thyroid function tests and hypothyroidism: Restoring serum TSH to reference range should be goal of replacement. BMJ 326: 1086-1087 [Full Text]  
• Sgarbi, J. A., Villaca, F. G., Garbeline, B., Villar, H. E., Romaldini, J. H. (2003). The Effects of Early Antithyroid Therapy for Endogenous Subclinical Hyperthyroidism in Clinical and Heart Abnormalities. J. Clin. Endocrinol. Metab. 88: 1672-1677 [Abstract] [Full Text]  
• Hegedus, L., Bonnema, S. J., Bennedbaek, F. N. (2003). Management of Simple Nodular Goiter: Current Status and Future Perspectives. Endocr. Rev. 24: 102-132 [Abstract] [Full Text]  
• Biondi, B., Palmieri, E. A., Lombardi, G., Fazio, S. (2002). Effects of Subclinical Thyroid Dysfunction on the Heart. ANN INTERN MED 137: 904-914 [Abstract] [Full Text]  
• Wemeau, J.-L., Caron, P., Schvartz, C., Schlienger, J.-L., Orgiazzi, J., Cousty, C., Vlaeminck-Guillem, V. (2002). Effects of Thyroid-Stimulating Hormone Suppression with Levothyroxine in Reducing the Volume of Solitary Thyroid Nodules and Improving Extranodular Nonpalpable Changes: A Randomized, Double-Blind, Placebo-Controlled Trial by the French Thyroid Research Group. J. Clin. Endocrinol. Metab. 87: 4928-4934 [Abstract] [Full Text]  
• Castro, M. R., Caraballo, P. J., Morris, J. C. (2002). Effectiveness of Thyroid Hormone Suppressive Therapy in Benign Solitary Thyroid Nodules: A Meta-Analysis. J. Clin. Endocrinol. Metab. 87: 4154-4159 [Abstract] [Full Text]  
• Auer, J., Berent, R., Weber, T., Eber, B. (2002). Thyroid hormone and arrhythmogenic activity. J Am Coll Cardiol 40: 574-575 [Full Text]  
• Chen, Y. i-J., Chen, Y.-C., Lin, C.-I., Chen, S.-A. (2002). Reply. J Am Coll Cardiol 40: 575-575 [Full Text]  
• Isley, W. L. (2002). Growth Hormone Therapy for Adults: Not Ready for Prime Time?. ANN INTERN MED 137: 190-196 [Abstract] [Full Text]  
• Aronow, W. S. (2002). Management of the Older Person With Atrial Fibrillation. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 57: M352-363 [Abstract] [Full Text]  
• Bosch, R. F, Nattel, S. (2002). Cellular electrophysiology of atrial fibrillation. Cardiovasc Res 54: 259-269 [Full Text]  
• Osman, F., Gammage, M. D., Sheppard, M. C., Franklyn, J. A. (2002). Cardiac Dysrhythmias and Thyroid Dysfunction - The Hidden Menace?. J. Clin. Endocrinol. Metab. 87: 963-967 [Abstract] [Full Text]  
• Bonnema, S. J., Bennedbak, F. N., Ladenson, P. W., Hegedus, L. (2002). Management of the Nontoxic Multinodular Goiter: A North American Survey. J. Clin. Endocrinol. Metab. 87: 112-117 [Abstract] [Full Text]  
• Chu, J. W., Crapo, L. M. (2001). The Treatment of Subclinical Hypothyroidism Is Seldom Necessary. J. Clin. Endocrinol. Metab. 86: 4591-4599 [Full Text]  
• Meier, C., Staub, J.-J., Roth, C.-B., Guglielmetti, M., Kunz, M., Miserez, A. R., Drewe, J., Huber, P., Herzog, R., Muller, B. (2001). TSH-Controlled L-Thyroxine Therapy Reduces Cholesterol Levels and Clinical Symptoms in Subclinical Hypothyroidism: A Double Blind, Placebo-Controlled Trial (Basel Thyroid Study). J. Clin. Endocrinol. Metab. 86: 4860-4866 [Abstract] [Full Text]  
• Toft, A. D. (2001). Subclinical Hyperthyroidism. NEJM 345: 512-516 [Full Text]  
• Drake, W. M., Howell, S. J., Monson, J. P., Shalet, S. M. (2001). Optimizing GH Therapy in Adults and Children. Endocr. Rev. 22: 425-450 [Abstract] [Full Text]  
• Wesche, M. F. T., Tiel-v Buul, M. M. C., Lips, P., Smits, N. J., Wiersinga, W. M. (2001). A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter. J. Clin. Endocrinol. Metab. 86: 998-1005 [Abstract] [Full Text]  
• Bakker, S. J. L., ter Maaten, J. C., Popp-Snijders, C., Slaets, J. P. J., Heine, R. J., Gans, R. O. B. (2001). The Relationship between Thyrotropin and Low Density Lipoprotein Cholesterol Is Modified by Insulin Sensitivity in Healthy Euthyroid Subjects. J. Clin. Endocrinol. Metab. 86: 1206-1211 [Abstract] [Full Text]  
• Klein, I., Ojamaa, K. (2001). Thyroid Hormone and the Cardiovascular System. NEJM 344: 501-509 [Full Text]  
• Al-Abadi, A C (2001). Subclinical thyrotoxicosis. Postgrad. Med. J. 77: 29-29 [Full Text]  
• Biondi, B., Palmieri, E. A., Fazio, S., Cosco, C., Nocera, M., Saccà, L., Filetti, S., Lombardi, G., Perticone, F. (2000). Endogenous Subclinical Hyperthyroidism Affects Quality of Life and Cardiac Morphology and Function in Young and Middle-Aged Patients. J. Clin. Endocrinol. Metab. 85: 4701-4705 [Abstract] [Full Text]  
• Toft, A D, Boon, N A (2000). GENERAL CARDIOLOGY: Thyroid disease and the heart. Heart 84: 455-460 [Full Text]  
• Peters, A., Ehlers, M., Blank, B., Exler, D., Falk, C., Kohlmann, T., Fruehwald-Schultes, B., Wellhoener, P., Kerner, W., Fehm, H. L. (2000). Excess Triiodothyronine as a Risk Factor of Coronary Events. Arch Intern Med 160: 1993-1999 [Abstract] [Full Text]  
• Ladenson, P. W., Singer, P. A., Ain, K. B., Bagchi, N., Bigos, S. T., Levy, E. G., Smith, S. A., Daniels, G. H. (2000). American Thyroid Association Guidelines for Detection of Thyroid Dysfunction. Arch Intern Med 160: 1573-1575 [Abstract] [Full Text]  
• Kreuzberg, U., Theissen, P., Schicha, H., Schroder, F., Mehlhorn, U., de Vivie, E. R., Boknik, P., Neumann, J., Grohe, C., Herzig, S. (2000). Single-channel activity and expression of atrial L-type Ca2+ channels in patients with latent hyperthyroidism. Am. J. Physiol. Heart Circ. Physiol. 278: H723-H730 [Abstract] [Full Text]  
• Canaris, G. J., Manowitz, N. R., Mayor, G., Ridgway, E. C. (2000). The Colorado Thyroid Disease Prevalence Study. Arch Intern Med 160: 526-534 [Abstract] [Full Text]  
• Bauer, D. C (2000). Review: sensitive thyrotropin testing in unselected inpatients has low diagnostic accuracy. Evid. Based Med. 5: 29-29 [Full Text]  
• Hanna, F W F, Lazarus, J H, Scanlon, M F (1999). Fortnightly review: Controversial aspects of thyroid disease. BMJ 319: 894-899 [Full Text]  
• Bonnema, S. J., Bertelsen, H., Mortensen, J., Andersen, P. B., Knudsen, D. U., Bastholt, L., Hegedus, L. (1999). The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function. J. Clin. Endocrinol. Metab. 84: 3636-3641 [Abstract] [Full Text]  
• Toft, A. D. (1999). Thyroid Hormone Replacement -- One Hormone or Two?. NEJM 340: 468-470 [Full Text]  
• Biondi, B., Fazio, S., Coltorti, F., Palmieri, E. A., Carella, C., Lombardi, G., Saccà, L. (1998). Reentrant Atrioventricular Nodal Tachycardia Induced by Levothyroxine. J. Clin. Endocrinol. Metab. 83: 2643-2645 [Full Text]  
• Hermus, A. R., Huysmans, D. A. (1998). Treatment of Benign Nodular Thyroid Disease. NEJM 338: 1438-1447 [Full Text]  
• Franklyn, J.A., Maisonneuve, P., Sheppard, M.C., Betteridge, J., Boyle, P. (1998). Mortality after the Treatment of Hyperthyroidism with Radioactive Iodine. NEJM 338: 712-718 [Abstract] [Full Text]  
• Laurberg, P., Pedersen, K. M., Hreidarsson, A., Sigfusson, N., Iversen, E., Knudsen, P. R. (1998). Iodine Intake and the Pattern of Thyroid Disorders: A Comparative Epidemiological Study of Thyroid Abnormalities in the Elderly in Iceland and in Jutland, Denmark. J. Clin. Endocrinol. Metab. 83: 765-769 [Abstract] [Full Text]  
• Papini, E., Petrucci, L., Guglielmi, R., Panunzi, C., Rinaldi, R., Bacci, V., Crescenzi, A., Nardi, F., Fabbrini, R., Pacella, C. M. (1998). Long-Term Changes in Nodular Goiter: A 5-Year Prospective Randomized Trial of Levothyroxine Suppressive Therapy for Benign Cold Thyroid Nodules. J. Clin. Endocrinol. Metab. 83: 780-783 [Abstract] [Full Text]  
• Nordyke, R. A., Reppun, T. S., Madanay, L. D., Woods, J. C., Goldstein, A. P., Miyamoto, L. A. (1998). Alternative Sequences of Thyrotropin and Free Thyroxine Assays for Routine Thyroid Function Testing: Quality and Cost. Arch Intern Med 158: 266-272 [Abstract] [Full Text]  
• (1998). Managing subclinical hypothyroidism. DTB 36: 1-3 [Abstract] [Full Text]  
• Peran, S., Garriga, M. J., Morreale de Escobar, G., Asuncion, M., Peran, M. (1997). Increase in Plasma Thyrotropin Levels in Hypothyroid Patients during Treatment due to a Defect in the Commercial Preparation. J. Clin. Endocrinol. Metab. 82: 3192-3195 [Abstract] [Full Text]  
• Woeber, K. A. (1997). Subclinical Thyroid Dysfunction. Arch Intern Med 157: 1065-1068 [Abstract]  
• Bauer, D. C., Brown, A. N. (1996). Sensitive Thyrotropin and Free Thyroxine Testing in Outpatients: Are Both Necessary?. Arch Intern Med 156: 2333-2337 [Abstract]  
• Krahn, A. D., Klein, G. J., Kerr, C. R., Boone, J., Sheldon, R., Green, M., Talajic, M., Wang, X., Connolly, S. (1996). How Useful Is Thyroid Function Testing in Patients With Recent-Onset Atrial Fibrillation?. Arch Intern Med 156: 2221-2224 [Abstract]  
• Vanderpump, M P J, Ahlquist, J A O, Franklyn, J A, Clayton, R N (1996). Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism. BMJ 313: 539-544 [Full Text]