Z. Song1, J. Kasmirski1, C. Wu1, A. Gillis1, J. Fazendin1, B. Lindeman1, H. Chen1 1University Of Alabama at Birmingham, Endocrine Surgery, Birmingham, Alabama, USA
Introduction:
Thyrotoxicosis is a hypermetabolic state characterized by elevated thyroid hormone levels, which can negatively affect end-organs such as the heart. Thyrotoxicosis management options include antithyroid drugs, radioactive iodine, and thyroidectomy. The impact of these treatments on long-term cardiac outcomes remains unclear. Our study aims to compare the effect of surgical versus nonsurgical treatments on the risk of new-onset cardiovascular complications in patients with thyrotoxicosis.
Methods:
Retrospective analysis of electronic medical records from United States institutions was performed within the TriNetX research network, spanning 2004 to 2024. Patients were identified through the thyrotoxicosis (E05) ICD-10 code and managed either surgically (with the CPT code for thyroidectomy) or non-surgically (history of antithyroid medication or iodine I-131 treatment, and the absence of the CPT code for thyroidectomy). The surgical and non-surgical cohorts were balanced by 1:1 propensity score matching (PSM) for age, sex, race, comorbidities, and cardiovascular medications. Kaplan-Meier analysis was then employed to calculate hazard ratios (HR) and 95% confidence intervals (CI) to assess the risk of new-onset arrhythmia, cerebral infarction and heart failure.
Results:
Of 161,677 patients with a diagnosis code of thyrotoxicosis, 22,698 (14.0%) underwent thyroidectomy, 28,693 (17.7%) were treated with radioactive iodine, while 110,286 (68.2%) were treated medically. Following PSM, the cohort consisted of 21,955 surgical patients and 21,955 nonsurgical patients. The majority were white (59.2%) and female (82.2%), with a mean age of 48 ± 17 years. Before the diagnosis of thyrotoxicosis, the prevalence of hypertension was 37.7% in the surgical group compared to 35.5% in the nonsurgical group (p<0.001); diabetes 15.3% versus 14.1% (p=0.003); and dyslipidemia 25.2% versus 24.0% (p=0.0023), respectively. During a median follow-up of 3.9 years after the diagnosis of thyrotoxicosis, patients who underwent thyroidectomy had a significantly lower risk of atrial fibrillation or flutter (HR 0.61, 95% CI 0.55–0.69) and ventricular arrhythmia (HR 0.82, 95% CI 0.76–0.89). Furthermore, thyroidectomy was associated with a significant decrease in the risk of new-onset cerebral infarction (HR 0.86, 95% CI 0.75–0.99) or developing heart failure (HR 0.72, 95% CI 0.65–0.79).
Conclusion:
In addition to definitive, rapid cure of thyrotoxicosis, thyroidectomy was shown to significantly reduce the risk of developing arrhythmia, cerebral infarction, and heart failure compared to nonoperative management.