title: Occult thyrotoxicosis in patients with atrial fibrillation and an acute arterial embolism.
abstract: Serum total thyroxine, triiodothyronine, and thyrotropin response to thyrotropin-releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial fibrillation: 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 II, and 2 patients in Group III. 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.
authors.affiliation: Department of Medicine, Hospital de Badalona Germans Trias i Pujol, Facultad de Medicina, Universidad Autónoma de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Monreal
authors.forename: E
authors.initials: E
authors.lastname: Lafoz
authors.forename: M
authors.initials: M
authors.lastname: Foz
authors.forename: A
authors.initials: A
authors.lastname: Sanmarti
authors.forename: I
authors.initials: I
authors.lastname: Salinas
authors.forename: L
authors.initials: L
authors.lastname: Audi
authors.forename: E
authors.initials: E
authors.lastname: Viver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D004617:Embolism / Q000150:complications*; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications*; D008297:Male; D013960:Thyroid Function Tests; D013971:Thyrotoxicosis / Q000150:complications / Q000175:diagnosis*; D013972:Thyrotropin / Q000097:blood
chemical_list: D013972:Thyrotropin