title: A Prospective Study on Cardiovascular Dysfunction in Patients with Hyperthyroidism and Its Reversal After Surgical Cure.
abstract: BACKGROUND
  Cardiovascular dysfunction (CVD) is a major cause of mortality and morbidity in hyperthyroidism. CVD and its reversibility after total thyroidectomy (TT) are not adequately addressed. This prospective case-control study evaluates the effect of hyperthyroidism on myocardium and its reversibility after TT.
  
  
  METHODS
  Surgical candidates of new onset hyperthyroidism, Group A (n = 41, age < 60 years) was evaluated with 2D Echocardiography, serum n-terminal probrain natriuretic peptide (NT-proBNP) at the time of diagnosis (Point A), after achieving euthyroidism (Point B) with antithyroid drugs, and 3 months after TT (Point C). 20 patients with nontoxic benign thyroid nodules undergoing TT served as controls (Group B).
  
  
  RESULTS
  Both groups were age and sex matched. Group A (n = 41) comprises Graves disease (n = 22) and Toxic Multinodular goiter (n = 19). At point A, CVD was evident in 26/41(63.4%), pulmonary hypertension (PHT) in 24/41(58.5%)--mild in 17/41(41.4%) and moderate in 7/41(17%)--dilated cardiomyopathy (DCM) in 8/41(19.5%), heart failure in 4/41(9.7%), and NT-proBNP elevated in 28/41(68.3%). At point B, recovery was observed in PHT 19/26(73.1%), DCM 4/8(50%), heart failure 4/4(100%), NT-proBNP in 3/28(10.7%). At Point C, further improvement occurred in PHT 23/24(95.8%), DCM 7/8(87.5%), heart failure 4/4(100%), and NT-proBNP in 24/28(85.7%).
  
  
  CONCLUSIONS
  Pulmonary hypertension is completely reversible at 3 months after TT and is the most common cardiac event in Hyperthyroidism. Various parameters of CVD improved consistently after surgical cure. NT-proBNP levels correlated well with the severity and duration of CVD and hence can be an objective tool in monitoring of hyperthyroid cardiac dysfunction.
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India. docmuthukumar@yahoo.com.
authors.forename: Sankaran
authors.initials: S
authors.lastname: Muthukumar
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India.
authors.forename: Dhalapathy
authors.initials: D
authors.lastname: Sadacharan
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ravikumar
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India.
authors.forename: Gajarajan
authors.initials: G
authors.lastname: Mohanapriya
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Hussain
authors.affiliation: Department of Endocrine Surgery, Madras Medical College, Chennai, India.
authors.forename: R V
authors.initials: RV
authors.lastname: Suresh
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000601:surgery*; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013965:Thyroidectomy; D055815:Young Adult