Occult Thyrotoxicosis in Patients with Atrial Fibrillation and an Acute Arterial Embolism

Monreal, M.; Lafoz, E.; Foz, M.; Sanmarti, A.; Salinas, I.; Audi, L.; Viver, E.
November 1988
Angiology;Nov1988, Vol. 39 Issue 11, p981
Academic Journal
Serum total thyroxine, triiodothyronine, and thyrotropin response to thyrotropin- releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial flbrillation: 33 patients with an acute arterial limb embolism (Group I), 31 patients with an acute embolic stroke (Group II), and 62 patients without any arterial occlusion (Group III). A blunted TRH-TSH test, suggestive of thyrotoxicosis, was found in 5 patients in Group I, 8 patients in Group 11, and 2 patients in Group IU. The diagnosis of hyperthyroidism was confirmed in 8 patients (by repeated TRH-TSH test and scintigraphy): 4 patients in Group I (12.1%) and 4 patients in Group II (12.9%). All of them had a nonvalvular atrial fibrillation. Thyrotoxicosis should not be recognized in 6 of them if TRH-TSH test was not performed, because peripheral hormone levels were normal. Five of these 8 patients with thyrotoxicosis had reversion to sinus rhythm after treatment with carbimazole, either spontaneously or after cardioversion. This outcome prevented prolongation of anticoagulant therapy for an indefinite time.


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