Endocrine Abstracts

Background: The clinical presentation of hyperthyroidism has been studied in the ambulatory caresetting. Our hospital performs a TSH test for all newly admitted patients.

Aim: To describe the clinical presentation of patients with overt hyperthyroidism during hospitalization and to study the association between thyroid hormone levels and the clinical picture.

Methods: A retrospective study of 250 hospitalized patients from an 11-year period (2008–2018) admitted to the internal medicine, geriatrics, or cardiology wards who had a confirmed diagnosis of overt hyperthyroidism.

Results: The mean age was 70 ± 15 years, with a female:male ratio of 1:1. Out of 250 patients, 174 (69%) suffered from previous cardiovascular disease and 111 (44%) presented with a cardiovascular syndrome, including active ischemic heart disease (29, 12%) decompensated congestive heart failure (83, 32%) or new onset atrial fibrillation/flutter (14, 6%). The most common underlying etiology was amiodarone induced thyrotoxicosis (53, 21%), closely followed by overtreatment of previously known hypothyroidism (50, 20%) and toxic multinodular goiter (42, 17%), while Graves’ disease was less common (18, 7%). In 51 (20%) an underlying cause could not be determined. No direct correlation was observed between the levels of fT4 and fT3 and any of the symptoms, signs or clinical syndromes; however, in the categorical analysis, elevated fT3 levels, rather than fT4, above the upper limit of normal range (ULN) was associated with cardiovascular presentation. The only symptom that was significantly related to high fT4 values was chest pain (P < 0.001) while high levels of fT3, in contrast, were associated with palpitations (P = 0.016), chest pain (P < 0.001) and cardiovascular syndromes in general (P = 0.007).

Conclusions: Most hospitalized patients with overt hyperthyroidism had cardiovascular comorbidities, while at the same time presenting with signs of active decompensated heart failure, arrhythmias or coronary artery disease as reasons for hospital admission in ±50% of the patients. Cardiovascular presentation was associated with high levels of fT3 rather than fT4.