Scientific article
Open access

Challenges in the Management of Atrial Fibrillation With Subclinical Hyperthyroidism

Published inFrontiers in endocrinology, vol. 12, 795492
Publication date2022
First online date2022-01-04

Subclinical thyroid disorders have a high prevalence among older individuals and women. Subclinical hypothyroidism is diagnosed by elevated serum levels of thyroid-stimulating hormone (TSH) with thyroxine levels within the reference range, and subclinical hyperthyroidism is diagnosed by low TSH in conjunction with thyroxine and triiodothyronine levels within reference ranges. Atrial fibrillation is the most commonly diagnosed cardiac arrhythmia and has been associated with an increased risk of mortality, heart failure, stroke, and depression. Mechanistic data from animal and human physiology studies as well as observational data in humans support an association of subclinical hyperthyroidism with atrial fibrillation. Guidelines recommend the measurement of TSH in the evaluation of new-onset atrial fibrillation. All patients with overt hyperthyroidism should be treated, and treatment of subclinical hyperthyroidism should be considered in patients older than 65 years with TSH < 0.4 mlU/L, or in younger patients with TSH < 0.1 mlU/L. Guidelines also recommend screening for AF in patients with known hyperthyroidism. Wearable devices that measure the heart electrical activity continuously may be a novel strategy to detect atrial fibrillation in patients at risk. In this review, we explore the interplay between thyroid hormones and atrial fibrillation, management controversies in subclinical hyperthyroidism, and potential strategies to improve the management of atrial fibrillation in patients with subclinical hyperthyroidism.

  • Amiodarone
  • Atrial fibrillation
  • Rate control
  • Rhythm control
  • Subclinical hyperthyroidism
  • Disease Management
  • Humans
  • Hyperthyroidism / complications
  • Hyperthyroidism / metabolism
  • Hyperthyroidism / physiopathology
  • Hyperthyroidism / therapy
  • Prevalence
  • Risk Factors
  • Thyrotropin / metabolism
  • Thyroxine / metabolism
  • Triiodothyronine / metabolism
Research group
Citation (ISO format)
GENCER, Baris et al. Challenges in the Management of Atrial Fibrillation With Subclinical Hyperthyroidism. In: Frontiers in endocrinology, 2022, vol. 12, p. 795492. doi: 10.3389/fendo.2021.795492
Main files (1)
Article (Published version)
ISSN of the journal1664-2392

Technical informations

Creation03/24/2022 4:27:00 AM
First validation03/24/2022 4:27:00 AM
Update time03/16/2023 6:37:51 AM
Status update03/16/2023 6:37:50 AM
Last indexation10/19/2023 6:08:39 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack