methimazole and Atrial-Fibrillation

Atrial fibrillation is exceedingly rare in children with structurally and functionally normal hearts. We present a novel case of a 15-year-old female with known hyperthyroidism who subsequently developed atrial fibrillation. She had been suffering from fatigue, heat intolerance and myalgias for 6 months. Her initial TSH was 0.01mU/L, and free T4 was 75.4 pmol/L, with a free T3 of >30.8 pmol/L. An electrocardiogram showed atrial fibrillation with a ventricular rate of 141 beats per minute. An echocardiogram demonstrated an enlarged left atrium and ventricle, with mild mitral regurgitation. She was treated with methimazole and underwent synchronized cardioversion. She subsequently returned to a euthyroid state and remained in normal sinus rhythm. In this case, we discuss the physiologic and arrhythmogenic properties of thyroid hormone, with a summary of the existing literature on atrial fibrillation in hyperthyroidism in children. Current guidelines for treatment of atrial fibrillation are also outlined.

Topics: Adolescent; Antithyroid Agents; Atrial Fibrillation; Electrocardiography; Female; Humans; Hyperthyroidism; Methimazole; Thyroid Function Tests; Treatment Outcome

Topics: Aged; Anticoagulants; Antithyroid Agents; Atrial Fibrillation; Female; Humans; Hyperthyroidism; Methimazole; Osteoporosis; Practice Guidelines as Topic; Risk Factors; Thyroid Function Tests; Thyrotropin; Thyroxine

Some precursor P wave changes on electrocardiogram (ECG) before the atrial fibrillation (AF) episodes occur in the hyperthyroidism. Our aim was to compare the effect of two antithyroid drugs (ATD) on P wave duration and dispersion (PWD) in patients with hyperthyroidism.. Fifty patients (13 men, 37 women; mean age 39.2+/-13.2 years) with newly diagnosed overt hyperthyroid patients with Graves' disease (GD) were enrolled in the prospective, randomized study. The maximum P wave duration (Pmax) and the minimum P wave duration (Pmin) were measured in all 12-lead surface ECGs. The patients were consecutively randomized to propylthiouracil (PTU) (n=24) and methimazole (MMZ) (n=26) groups. Electrocardiogram was repeated within euthyroid state after the 18-month ATD treatment. Student t-test, Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The differences between pre- and post-treatment measurements within groups were evaluated by Wilcoxon Sign Rank test. The correlation of data was tested by using Spearman correlation analysis.. The maximum P wave duration (Pmax) was 90 (80-110) and 90 (90-110) msec, (p=0.586), and PWD was 35 (22.5-48.7) and 40 (30-40) msec, respectively (p=0.952) in PTU and MMZ groups. After euthyroidism was achieved, Pmax was 80 (80-90) and 87.5 (80-90) msec (p=0.676), and PWD was 27.5 (20-35) and 27.5 (20-30) msec in PTU and MMZ groups, respectively (p=0.540). After ATD treatment PWD decreased (p=0.009 and p<0.001, respectively) in both of PTU and MMZ groups. However effects of ATD on PWD change were similar (p=0.486).. P wave duration and PWD are found to be prolonged in hyperthyroid patients with GD. Both propylthiouracil and methimazole reduce the P wave duration and dispersion. Thus, we can conclude that improvements in atrial conduction properties are not associated with the type of ATD but with only achievement of euthyroidism.

Topics: Adult; Antithyroid Agents; Atrial Fibrillation; Electrocardiography; Female; Graves Disease; Heart Conduction System; Humans; Male; Methimazole; Propylthiouracil; Prospective Studies; Thyroid Hormones

To investigate the clinical effect of prednisone on hyper thyroid atrial fibrillation associated with Graves disease (HAFGD).. Twenty-four patients with hyperthyroid atrial fibrillation associated with Graves disease were divided into two groups: traditional antithyroid group (10 cases, with 2 males and 8 females, treated by methimazole 15 approximately 30 mg/d and propranolol 15 approximately 30 mg/d) and prednisone group (14 cases with 3 males and 11 females, treated by methimazole 15 approximately 30 mg/d, propranolol 15 approximately 30 mg/d, and prednisone 30 mg/d). The effects of these two remedies on reversion from atrial fibrillation to sinus rhythm were compared.. The cardiac rhythm reverted to sinus rhythm in 12 out of the 14 cases in prednisone group with a reversion rate of 86% and the mean reversion time of 3.8 months (range 3.8 +/- 2.6 months), and in 4 out of the 10 cases in traditional antithyroid remedy group with the mean reversion rate of 40% and mean reversion time of 2.8 months (range 2.8 +/- 1.0 months). The reversion rate was significantly higher in prednisone group than in the traditional remedy group (P < 0.05).. Treatment of prednisone is more beneficial to reversion of atrial fibrillation into sinus rhythm among patients with HARGD.

Topics: Adult; Aged; Atrial Fibrillation; Female; Glucocorticoids; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Prednisone; Thyrotropin

Topics: Abdominal Pain; Antithyroid Agents; Ascites; Atrial Fibrillation; Diagnosis, Differential; Echocardiography, Transesophageal; Electrocardiography; Female; Heart Failure; Humans; Hyperthyroidism; Magnetic Resonance Imaging, Cine; Medication Adherence; Methimazole; Metoprolol; Middle Aged; Paracentesis; Thyroid Function Tests

A 62-year-old woman with a history of partially treated Graves disease and hypertension presented with approximately 3 weeks of worsening fatigue, lower extremity myalgias, and shortness of breath. Her medical history included a thyroid radiofrequency ablation several years earlier. Following the ablation, she was found to have some residual thyroid activity, negating the need for therapy. She was lost to follow-up after months of normal thyroid-stimulating hormone values. On this presentation, the patient was noted to be in atrial fibrillation with a rapid ventricular rate, and although she presented alert and oriented initially, she developed progressive inattentiveness and confusion while in the ED. The patient was transferred to the medical ICU for further management of her rapid heart rate and progressive delirium.

Topics: Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Anticoagulants; Antithyroid Agents; Atrial Fibrillation; Delirium; Disseminated Intravascular Coagulation; Dyspnea; Fatal Outcome; Fatigue; Female; Femoral Artery; Graves Disease; Heparin; Humans; Hydrocortisone; Ischemia; Lower Extremity; Methimazole; Middle Aged; Myalgia; Pneumoperitoneum; Popliteal Artery; Potassium Iodide; Propranolol; Radiofrequency Ablation; Thrombosis; Thyroid Crisis; Tibial Arteries; Venous Thrombosis

Thyrotropin-secreting adenoma (TSHoma) is rare. Even though the thyrotoxicosis is mild in patients with TSHoma, it is still a rare cause of arrhythmia, ignore of mild disfunction of thyroid function of TSHoma can lead to the delayed diagnosis of pituitary tumor or leading to recurring of complications. Graves' disease is an auto-immue endocrinological disorder. Association of TSHoma and Graves's disease is extremely rare. Coexistence of these two diseases made the diagnosis and treatment complicated.. This patient was a 55-year-old man who had been referred to the department of endocrinology and metabolism of the West China Hospital due to recurrent atrial fibrillation (AF) and thyroxicosis.. Examinations revealed pituitary thyrotropin-secreting macroadenoma with Graves' disease.. We conducted transsphenoidal surgery. Thyrozol was used to treat the recurrence of Graves' disease after pituitary surgery.. The TSHoma was successfully cured, and recurrent Graves' disease was controlled very well.. The association of TSHoma and Graves' disease is extremely rare. Even though the clinical features of thyrotoxicosis are milder in patients with TSHoma, thyroid function tests are still important clinical assessment of patients with AF, which is an arrhythmia associated with hyperthyroidism. TSHoma is a rare cause of thyrotoxicosis; however, ignoring of the mild disfunction caused by TSHoma can lead to the delayed diagnosis of pituitary tumors or to recurring of complications of TSHoma.

Topics: Antithyroid Agents; Atrial Fibrillation; Catheter Ablation; China; Graves Disease; Humans; Magnetic Resonance Imaging; Male; Methimazole; Middle Aged; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Recurrence; Thyrotoxicosis; Thyrotropin

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Atrial Fibrillation; Febrile Neutropenia; Female; Humans; Methimazole; Thyrotoxicosis

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population.

Topics: Aged, 80 and over; Antithyroid Agents; Atrial Fibrillation; Female; Goiter, Nodular; Heart Failure; Humans; Hyperthyroidism; Methimazole; Receptors, Thyrotropin; Recurrence; Thyrotoxicosis; Treatment Outcome

We report a case of a 67-year-old woman with stage IIIB locally advanced non-small cell lung cancer who had also suffered from hyperthyroidism with persistent atrial fibrillation (AF). Thiamazole provided euthyroid status, but medication failed to resolve AF. A computed tomography (CT)-scan revealed a 5×5-cm mass in the left hilar region that involved the left atrium (LA) and bifurcation of the pulmonary artery. Left pneumonectomy, LA partial resection and reconstruction of the bifurcation of the pulmonary artery were performed. In addition, a maze procedure was performed using cardiopulmonary bypass and cardiac arrest. We present the first case report of advanced lung cancer surgery with a maze procedure. Follow-up by CT-scan 34 months later did not show any recurrence and attacks of AF (no medication after surgery) were completely resolved after the operation.

Topics: Aged; Antithyroid Agents; Atrial Fibrillation; Blood Vessel Prosthesis Implantation; Carcinoma, Non-Small-Cell Lung; Cardiopulmonary Bypass; Catheter Ablation; Female; Heart Arrest, Induced; Heart Atria; Humans; Hyperthyroidism; Lung Neoplasms; Lymph Node Excision; Methimazole; Neoplasm Invasiveness; Neoplasm Staging; Pneumonectomy; Pulmonary Artery; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Amlodipine; Atrial Fibrillation; Digoxin; Female; Graves Disease; Humans; Hypertension, Pulmonary; Methimazole; Recurrence; Syncope; Treatment Outcome; Vertigo

Topics: Adrenergic beta-Antagonists; Aged; Agranulocytosis; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Atrial Fibrillation; Chest Pain; Cholangitis; Glucocorticoids; Humans; Hyperthyroidism; Hypothyroidism; Male; Methimazole; Plasmapheresis

Topics: Acidosis; Adult; Antithyroid Agents; Atrial Fibrillation; Biotransformation; Carbimazole; Diffusion; Drug Administration Schedule; Humans; Hyperthyroidism; Kidney Failure, Chronic; Male; Methimazole; Prodrugs; Renal Dialysis

Plasma immunoreactive atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP), serum thyroxine (T4), triiodothyronine (T3), and thyrotropin (TSH) concentrations were measured in 11 patients with thyrotoxicosis and atrial fibrillation (group 1), in 5 patients with thyrotoxicosis and sinus cardiac rhythm (group 2) and in 8 healthy subjects in comparable age. Patients with thyrotoxicosis were studied before and after treatment with methimazole (3 x 20 mg daily) during 10 days. During treatment sinus cardiac rhythm returned in 6 patients with initial fibrillation (group 1a) while 5 patients still presented atrial fibrillation at the end of the study (group 1b). All patients from group 2 maintained a sinus cardiac rhythm throughout the study. Median plasma concentrations of ANP and cGMP before treatment in patients from group 1 were higher: 43.8 pmol/l and 11.0 nmol/l, respectively than in patients from group 2: 20.0 pmol/l (p < 0.005) and 6.5 nmol/l (p < 0.01), respectively. In all groups of patients methimazole treatment resulted in a significant decrease of plasma ANP and cGMP concentrations in parallel to a reduction of serum T3 and T4 levels. After therapy, plasma ANP and cGMP levels in patients from group 1a were not significantly different from those in patients from group 2, while in patients from group 1b remained slightly elevated. Presented results suggest that atrial fibrillation in patients with thyrotoxicosis represents an important factor augmenting plasma ANP and cGMP levels, in addition to the stimulatory effect exerted by thyroid hormones. However, the marked reduction of serum thyroid hormones produced by short-term methimazole treatment in patients with thyrotoxicosis was associated with parallel decrease of plasma ANP and cGMP levels toward normal values. Therefore, the influence of thyroid hormones on plasma ANP and cGMP concentrations seems relatively more important than the effect of atrial fibrillation.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Cyclic GMP; Female; Humans; Methimazole; Middle Aged; Thyroid Hormones; Thyrotoxicosis

We treated a 78-year-old patient with hyperthyroidism and atrial fibrillation with amiodarone 1200 mg/day for 3 days and methimazole 60 mg/day. Sinus rhythm was restored within 3 days and serum levels of triiodothyroxine returned to normal within 4 days. A transient increase in serum rT3 concentrations was observed. Amiodarone associated with methimazole was useful in the management of atrial fibrillation and hyperthyroidism in our patient.

Topics: Aged; Amiodarone; Atrial Fibrillation; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Methimazole; Thyroid Hormones

Topics: Adult; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Complexes, Premature; Electrocardiography; Heart Block; Heart Ventricles; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Propranolol; Respiration