Cardiovascular Events in Patients With Thyroid Storm

Zainulabedin Waqar; Sindhu Avula; Jay Shah; Syed Sohail Ali


J Endo Soc. 2021;5(6) 

In This Article


Cardiovascular events after hospitalization with thyroid storm were significantly associated with increased age, as seen in Table 1 (44.2 years vs 38.6 years in those without CEs). Though there was not an apparent difference in gender, more females were diagnosed with thyroid storm than males in those with and without CEs. There were more white patients diagnosed with CEs than without (41.1% vs 37.5%), while the inverse was true for black patients (32.1% with CE vs 34.8% without) and other races (26.8% with CE vs 27.8% without), to a significant degree (P = 0.008).

When further subclassifying cardiac events divided in Table 2, patients noted with arrhythmia were noted to be younger than those with ischemic events or acute heart failure (44.1 years, 51.4 years, and 50.7 years, respectively).

Patients with obesity and chronic obstructive pulmonary disease (COPD) were more likely to experience CEs (obesity 6.9% vs 5.3%, P = 0.005; COPD, 16.3% vs 13.5%, P = 0.0014). When further analyzed, obesity was noted to be associated with a higher percentage of patients with ischemic events (13.3%). Chronic liver disease was also noted as being present in a greater proportion of patients with CEs (2.6% vs 1.7%, P = 0.02) and in a higher proportion of patients with acute heart failure (5.4%). Smokers were also more likely to have CEs (35.2% vs 32.2%, P = 0.01) and had about the same percentage of patients with ischemic events, acute heart failure, and arrhythmia (33.3%, 36%, and 35.3%, respectively).

No significant difference was noted for patients with hypertension, diabetes, and chronic renal disease when comparing patients with CV disease wth those without CV disease. However, hypertension and diabetes were noted to be more common in patients with ischemic events (63.3% and 26.7%, respectively) compared with acute heart failure or arrhythmias (38.7% and 39%; 6.3% and 11.4%, respectively). There was no difference in patients hospitalized with thyroid storm experiencing CEs in patients with a median income or on the location of hospital, but it was noted to have a higher percentages of patients in the lowest income quartile; also noted to have the higher percentage of patients treated in the southern region (45.3% of total patients with no CEs and 45.7% of total patients with CEs).

Interestingly, alcohol abuse was noted in patients without CV disease but not in those with CV disease (4.6% vs 3.3%, P = 0.008). When subclassified in CEs, a larger portion were noted to have ischemic events.

Outcomes for patients with CEs and those without CEs, patients were noted to have higher mortality, length of stay, and hospitalizations costs as seen in Table 3. A larger portion of ischemic events had a higher mortality rate (16.7%), a significantly longer median length of stay (8.5 days), as well as the highest hospitalization costs.

Arrhythmia types are subclassified in Table 4, with the largest number of patients with atrial fibrillation (1790) followed by tachycardia (890) and atrial flutter (260).