Curious Clinicians Episode 77 - Irregularly Irregular

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ONLINEABIM MOC Part 2AMAMOCPodcastsCurious Clinicians

Instructions

Wednesday, September 27, 2023, 2:00 PM - Sunday, September 27, 2026, 11:59 PM

Why is hyperthyroidism associated with atrial fibrillation?

Many of us have evaluated for hyperthyroidism in patients with new-onset atrial fibrillation. The association between hyperthyroidism and sinus tachycardia may make sense, particularly given that other endocrine conditions associated with sympathetic surge (e.g., pheochromocytoma) show the same. However, the association with atrial fibrillation (AF) isn’t immediately apparent.

And there is an association. From large cohort studies, we know that the relative risk of AF in overt hyperthyroidism is about 3-6x above the baseline risk. In addition to that, if you have subclinical hyperthyroidism, your risk also increases in approximately a linear fashion. Even within the reference range, as free T4 increases you see this association. At the lower end, the hazard ratio is ~1.2 and increases to 1.5 at the higher end of the reference range.And there is an association. From large cohort studies, we know that the relative risk of AF in overt hyperthyroidism is about 3-6x above the baseline risk. In addition to that, if you have subclinical hyperthyroidism, your risk also increases in approximately a linear fashion. Even within the reference range, as free T4 increases you see this association. At the lower end, the hazard ratio is ~1.2 and increases to 1.5 at the higher end of the reference range.

1. Summarize the effect of thyroid hormone on the cardiac conduction system.
2. Identify current research on thyroid hormone supplementation and atrial fibrillation.
3. Apply the physiology of hyperthyroidism to its clinical presentation with atrial fibrillation.

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The planning committee members report having no relevant financial relationships to disclose:

Hannah Abrams 
Tony Breu
Avi Cooper

In support of improving patient care, this activity has been planned and implemented by Curious Clinicians and VCU Health Continuing Education. VCU Health Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

 

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AMA PRA Category 1 Credits™ (0.50 hours), ABIM MOC Part 2 (0.50 hours), Non-Physician Attendance (0.50 hours)