Occult thyrotoxicosis in patients with atrial fibrillation and an acute arterial embolism.
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.
Monreal
M
M
Department of Medicine, Hospital de Badalona Germans Trias i Pujol, Facultad de Medicina, Universidad Autónoma de Barcelona, Spain.
Lafoz
E
E
Foz
M
M
Sanmarti
A
A
Salinas
I
I
Audi
L
L
Viver
E
E
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
D013972:Thyrotropin