Cardiac effects of severe hyperthyroidism and their changes in the long-term period after surgical treatment

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V.O. Shidlovsky
O.V. Shidlovsky
M.I. Sheremet
I.M. Pavlovsky
G.S. Kurochkin
V.V. Kravtsiv
O.V. Skochilo
G.P. Haplyk


Background. The result of surgical treatment of goiter with severe thyrotoxicosis may be an improvement in general condition and physical activity, a decrease and/or elimination of clinical manifestations of thyrotoxic cardiomyopathy (effective treatment), or a worsening of the general condition (ineffective treatment). From the standpoint of such approach, the long­term results of surgical treatment of toxic goiter with severe thyrotoxicosis have not been sufficiently studied. The purpose was to investigate the long­term effects of surgical treatment of patients with toxic goiter and severe thyrotoxicosis with a priority study of changes in cardiac activity and physical activity. Materials and methods. Studies have been carried out in 123 surgically treated patients with severe toxic goiter. Patients’ age ranged from 21 to 74 years. The duration of thyrotoxicosis was from 18 to 74 months. Indications for surgical treatment were frequent relapses of thyrotoxicosis, progression of thyrotoxic cardiomyopathy against the background of thyrostatic therapy with the development of heart rhythm disorders and heart failure. Structural and functional changes in the heart according to B­mode echocardiography, cardiac disorders according to the results of daily Holter monitoring, physical activity according to a six­minute walk test have been studied. Long­term effects of treatment have been evaluated by gradation developed by us: good, satisfactory, unsatisfactory result and ineffective treatment. Results. It has been found that the surgical treatment of patients with toxic goiter and severe thyrotoxicosis allows eliminating thyrotoxicosis and in some patients — heart rhythm disorders, reducing the severity of clinical manifestations of thyrotoxic cardiomyopathy, improving physical activity and general condition. Studies have shown that the results of surgical treatment depended on the severity of heart rhythm disorders and heart failure, i.e. the effects of thyrotoxicosis, which develop against the background of thyrotoxic cardiomyopathy. Good and satisfactory results of surgical treatment have been obtained in 55 (44.7 %) cases, unsatisfactory results — in 40 (32.5 %) patients, and the treatment was ineffective in 28 (22.8 %) persons. Conclusions. Surgical treatment of patients with toxic goiter and severe thyrotoxicosis helps achieve positive results: to eliminate thyrotoxicosis, reduce the severity of clinical manifestations of thyrotoxic cardiomyopathy, improve cardiac activity, physical activity and general condition of patients. The long­term results of surgical treatment of patients with severe thyrotoxicosis depend on the duration of the disease, drug therapy of thyrotoxicosis and the age of the patients. With an increase in these values, treatment results deteriorate. Among existing indications for the surgical treatment of patients with toxic goiter and manifestations of severe thyrotoxicosis, the first and most important one is the presence of thyrotoxic cardiomyopathy with heart rhythm disorders. The universal indicator for predicting long­term results of surgical treatment of patients with toxic goiter is the distance covered during a six­minute walk test.

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Shidlovsky, V., O. Shidlovsky, M. Sheremet, I. Pavlovsky, G. Kurochkin, V. Kravtsiv, O. Skochilo, and G. Haplyk. “Cardiac Effects of Severe Hyperthyroidism and Their Changes in the Long-Term Period After Surgical Treatment”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 15, no. 8, Sept. 2021, pp. 619-27, doi:10.22141/2224-0721.15.8.2019.191685.
Original Researches


Makarov IV, Galkin RA, Andreev MM. Long-term results and their prognosis in surgical treatment of Grave''s disease. Endocrine Surgery. 2013;7(2):45-51. (in Russian).

Kharnas SS, Mamaeva SK. Long-term results and quality of life after surgical treatment of diffuse toxic goiter. Endocrine Surgery. 2008;2(1):10-14. (in Russian).

Aristarkhov VG, Kvasov AV, Donyukov AI, Aristarkhov RV, Biryukov SV, Pusin DA. Comparative long-term results of surgical treatment of patients with diffuse toxic goiter. Khirurgiya. Zhurnal imeni NI Pirogova. 2017;(8):13-17. doi: 10.17116/hirurgia2017813-17. (in Russian).

Ertek S, Cicero AF. Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology. Arch Med Sci. 2013 Oct 31;9(5):944-52. doi: 10.5114/aoms.2013.38685.

Shimizu T, Koide S, Noh JY, Sugino K, Ito K, Nakazawa H. Hyperthyroidism and the management of atrial fibrillation. Thyroid. 2002 Jun;12(6):489-93. doi: 10.1089/105072502760143863.

Babenko AYu, Grineva EN, Solncev VN. Determinants of development and preservation of atrial fibrillation at thyrotoxicosis. Klinicheskaia I eksperimentalnaia tiroidologia. 2013;9(1):29-37. (in Russian).

Marusenko IM, Petrova EG. Hyperthyroidism and Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2017;13(3):398-402. doi: 10.20996/1819-6446-2017-13-3-398-402. (in Russian).

Skvortsov VV, Fomina NG, Emel'ianov DN. Current aspects of pharmacotherapy of heart failure in patients with thyrotoxic myocardial dystrophy (cardiopathy). Lekarstvennyj vestnik. 2014;8(55):39-47. (in Russian).

Kravtsiv VV, Shidlovskyi VO, Shidlovskyi OV. Thyrotoxic Cardiomyopathy and Heart Failure in Patients with Toxic Goiter. Changes after Surgery. Galician Medical Journal. 2016;23(3):31-33. doi: 10.21802/gmj.2016.3.4. (in Ukrainian).

Brandt F, Thvilum М, Almind D, et al. Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One. 2013 Jun 20;8(6):e66711. doi: 10.1371/journal.pone.0066711.

Brandt F1, Green A, Hegedüs L, Brix TH. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality. Eur J Endocrinol. 2011 Oct;165(4):491-7. doi: 10.1530/EJE-11-0299.

Franklyn JA, Sheppard MC, Maisonneuve P. Thyroid function and mortality in patients treated for hyperthyroidism. JAMA. 2005 Jul 6;294(1):71-80. doi: 10.1001/jama.294.1.71.

Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006 Mar 1;295(9):1033-41. doi: 10.1001/jama.295.9.1033.

Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.

Kovalenko VM, Sychov OS, DolzhenkoMM, Ivaniv JuA, Dejak SI, Potashev SV. Quantitative echocardiographic evaluation of heart cavities: Guidelines of the working group on functional diagnostics of the Association of Cardiologists of Ukraine and the All-Ukrainian Association of Specialists in Echocardiography. Available from: Accessed: October 19, 2016. (in Ukrainian).

Voronkov LG, Amosova KM, Bagriy AE, Dziak GV, et al. Guidelines of the Ukrainian Association of Cardiology of the diagnosis, treatment and prevention of chronic heart failure in adults (short version). East European Journal of Internal and Family Medicine. 2015;(1):65-71. doi: 10.15407/internalmed2015.01.065. (in Ukrainian).

Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128.