Cardiovascular Events in Patients with Thyroid Storm

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

doi:10.1210/jendso/bvab040

Cardiovascular Events in Patients with Thyroid Storm

J Endocr Soc. 2021 Mar 11;5(6):bvab040. doi: 10.1210/jendso/bvab040. eCollection 2021 Jun 1.

Authors

Zainulabedin Waqar¹, Sindhu Avula², Jay Shah^{1

2}, Syed Sohail Ali²

Affiliations

¹ Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA.
² Department of Cardiology, Mercy St Vincent Medical Center, Toledo, OH 43608, USA.

Abstract

Context: Thyroid storm can present as a multitude of symptoms, the most significant being cardiovascular (CV). It is associated with various manifestations such as cardiac arrhythmia, heart failure, and ischemia. However, the frequencies of events and characteristics associated with patients that experience these events are not known.

Methods: Study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015. Total hospitalizations of thyroid storm were identified using appropriate ICD-9 diagnostic codes. The analysis was performed using SAS.

Objective: To better understand the frequency and characteristics CV occurrences associated with thyroid storm, through a retrospective analysis of thyroid storm hospital admissions.

Design: The study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015.

Setting: Total hospitalizations of thyroid storm were identified using International Classification of Diseases (ICD)-9 diagnostic codes. The analysis was performed using Statistical Analysis System (SAS).

Results: A total of 6380 adult hospitalizations were included in the final analysis, which includes 3895 hospitalizations with CV events (CEs). Most frequently associated CEs were arrhythmia (N = 3770) followed by acute heart failure (N = 555) and ischemic events (N = 150). Inpatient mortality was significantly higher in patients with CEs compared with those without CEs (3.5% vs 0.2%, P < 0.005). The median length of stay was also higher in patients with CEs compared with those without CEs (4 days vs 3 days, P < 0.0005). Atrial fibrillation was the most common arrhythmia type, followed by nonspecified tachycardia.

Conclusions: In patients who were hospitalized due to thyroid storm and associated CEs significantly increased in-hospital mortality, length of stay, and cost. Patients with obesity, alcohol abuse, chronic liver disease, and COPD were more likely to have CEs. Patients with CV complications were at higher risk for mortality. In-hospital mortality increased with ischemic events and acute heart failure. Further evaluation is needed to further classify the type of arrhythmias and associated mortality.

Keywords: arrhythmia; cardiovascular disease; thyroid storm.