propylthiouracil and Atrial-Fibrillation

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

A shortening of the atrial refractory period has been considered as the main mechanism for the increased risk of atrial fibrillation in hyperthyroidism. However, other important factors may be involved.. Our objective was to determine the activity of abnormal supraventricular electrical depolarizations in response to elevated thyroid hormones in patients without structural heart disease.. Twenty-eight patients (25 females, three males, mean age 43+/-11 yr) with newly diagnosed and untreated hyperthyroidism were enrolled in a prospective trial after exclusion of heart disease. Patients were followed up for 16 +/- 6 months and studied at baseline and 6 months after normalization of serum TSH levels.. The incidence of abnormal premature supraventricular depolarizations (SVPD) and the number of episodes of supraventricular tachycardia was defined as primary outcome measurements before the start of the study. In addition, heart rate oscillations (turbulence) after premature depolarizations and heart rate variability were compared at baseline and follow-up.. SVPDs decreased from 59 +/- 29 to 21 +/- 8 per 24 h (P = 0.003), very early SVPDs (so called P on T) decreased from 36 +/- 24 to 3 +/- 1 per 24 h (P < 0.0001), respectively, and nonsustained supraventricular tachycardias decreased from 22 +/- 11 to 0.5 +/- 0.2 per 24 h (P = 0.01) after normalization of serum thyrotropin levels. The hyperthyroid phase was characterized by an increased heart rate (93 +/- 14 vs. 79 +/- 8 beats/min, P < 0.0001) and a decreased turbulence slope (3.6 vs. 9.2, P = 0.003), consistent with decreased vagal tone. This was confirmed by a significant decrease of heart rate variability.. Hyperthyroidism is associated with an increased supraventricular ectopic activity in patients with normal hearts. The activation of these arrhythmogenic foci by elevated thyroid hormones may be an important causal link between hyperthyroidism and atrial fibrillation.

Topics: Action Potentials; Adult; Antithyroid Agents; Atrial Fibrillation; Carbimazole; Echocardiography; Electric Stimulation; Female; Heart Rate; Humans; Hyperthyroidism; Male; Middle Aged; Propylthiouracil; Tachycardia, Supraventricular

P-wave duration is defined as the time measured from the onset to the offset of the P-wave in surface electrocardiogram (ECG). Prolonged P wave duration and increased P wave dispersion (PWD) have been reported to carry an increased risk for atrial fibrillation.. Our aim was to evaluate the role of hyperthyroidism on P wave duration and dispersion, to investigate the effect of anti-thyroid therapy on P wave duration and dispersion.. A total of 44 consecutive subjects (22 patients with newly diagnosed overt hyperthyroidism and 22 randomly selected euthyroid healthy subjects) were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment, in the first and third months of the 6-8 mg/kg/day propylthiouracil therapy. Patients were followed-up for 3 months.. Patient and control groups were consisted of age and sex matched subjects. Baseline left atrial diameter was similar between the patient and control groups (3.4+/-0.3 cm and 3.4+/-0.3 cm respectively, p=0.813). The maximum P-wave duration (P maximum) was 113.1+/-6.6 and 105.7+/-4.1 ms in patient and control groups (p=0.001). PWD was 31.5+/-9.5 and 25.2+/-5.9 ms in patient and control groups respectively (p=0.015). At the third month of propylthiouracil treatment P maximum and PWD were decreased in the patient group at statistically significant level and returned back in normal limits (p<0.001 and p=0.001).. P wave duration and PWD are found prolonged in hyperthyroid patients and propylthiouracil treatment decreased them effectively. This mechanism may establish how the anti-thyroid treatment may prevent the development of atrial fibrillation in hyperthyroid patients.

Topics: Adult; Antithyroid Agents; Atrial Fibrillation; Electrocardiography; Female; Follow-Up Studies; Graves Disease; Humans; Male; Middle Aged; Propylthiouracil; Thyroid Hormones

Propylthiouracil has been in use for more than half a century for the treatment of hyperthyroidism. While it is largely known to cause agranulocytosis, its association with aplastic anemia is rarely heard of. Our case will be the third in literature to suggest aplastic anemia as a manifestation of propylthiouracil, which unfortunately culminated in the death of the patient.. A 67-year-old female, with recently diagnosed metastatic adenocarcinoma of the lung, developed hyperthyroidism after being started on Nivolumab and Iplimumab. After she developed atrial fibrillation, she was started on propylthiouracil to control the thyroid activity. Soon after that, she was admitted with severe neutropenia, which progressed to pancytopenia confirmed as aplastic anemia on a bone marrow biopsy. Despite discontinuation of propylthiouracil and aggressive treatment, she developed septic shock and multi-organ failure, leading to her death.. Aplastic anemia has been sparingly reported as an extremely rare complication of propylthiouracil. Further adding to the ambiguity is the unknown etiology and lack of specific therapy for the complication when attributed to propylthiouracil. The disease can carry an extremely poor prognosis if untreated, as proven by our case. Due to the same reasons, we recommend that further investigations be done to elucidate the pathogenesis and assist with treatment of the disease when caused by propylthiouracil.

Topics: Aged; Anemia, Aplastic; Antithyroid Agents; Atrial Fibrillation; Female; Humans; Propylthiouracil

Propylthiouracil (PTU) therapy is associated with a variety of adverse reactions, among the most rare being interstitial pneumonia. To date, this has been reported in four Asian patients with autoimmune hyperthyroidism. Here we describe a Caucasian woman who developed a bronchiolitis obliterans organizing pneumonia (BOOP)-like interstitial pneumonia after PTU administration for amiodarone-induced thyrotoxicosis.. The patient was a 68-year-old woman who had been treated with amiodarone for chronic atrial fibrillation starting in May 2004. She had been a heavy smoker with a history of hypertension but no dust exposures. In October 2006, amiodarone was stopped after she developed thyrotoxicosis. In January 2007 serum thyroid-stimulating hormone (TSH) was 0.01 mIU/L (0.35-4.94) and free T4 was 17.5 pg/mL (7 to 15). She was initially started on methimazole and then changed to PTU after she developed pruritus. She developed severe dyspnea 9 months after starting PTU. At the time she was also taking warfarin, enalapril, and sotalol. Chest X-ray showed diffuse interstitial peripheral opacities and transbronchial lung biopsy revealed subacute lung injury with organizing pneumonia with hyperplasia of the alveolar type 2 pneumocytes, and characteristics of BOOP-like interstitial pneumonia. Signs and symptoms progressively improved after PTU discontinuation as confirmed at X-ray and computed tomography (CT) scan of the chest and by respiratory function tests. She has been recurrence free for 4 years after stopping PTU.. This woman of Caucasian ancestral origin developed BOOP-like interstitial pneumonia after PTU treatment for apparent amiodarone-induced thyrotoxicosis, with resolution of her lung disease after stopping PTU. Tests for TSH receptor antibodies, thyroid peroxidase antibodies, and antinuclear cytoplasmic autoantibody were negative. Thyroid ultrasound was consistent with thyroiditis without nodules.. PTU-associated interstitial pneumonia is not limited to patients of Asian origin or those with autoimmune thyroid disease. PTU must be withdrawn in the presence of respiratory symptoms and documented interstitial pneumonia. X-ray films, CT-scan, respiratory function tests, and lung biopsy are needed to diagnose PTU-induced interstitial pneumonia with certainty and to monitor the evolution of the disease after PTU discontinuation.

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Atrial Fibrillation; Cryptogenic Organizing Pneumonia; Female; Humans; Propylthiouracil; Radiography; Thyrotoxicosis; White People

Topics: Adult; Antithyroid Agents; Atrial Fibrillation; Atrioventricular Block; Diagnosis, Differential; Electrocardiography; Humans; Hyperthyroidism; Male; Propylthiouracil; Syncope; Thyroid Function Tests

We report a case of Graves' disease in a patient on regular hemodialysis. The patient also suffered from Wolff-Parkinson-White (WPW) syndrome and paroxysmal atrial fibrillation, which may both have been manifestations of the Graves' disease because of the increased oxygen demand. To our knowledge, this is the first case to illustrate the usefulness of the antithyroid agent propylthiouracil for Graves' disease complicated by endstage renal disease (ESRD) and WPW syndrome.

Topics: Antithyroid Agents; Atrial Fibrillation; Graves Disease; Humans; Kidney Failure, Chronic; Male; Middle Aged; Propylthiouracil; Renal Dialysis; Wolff-Parkinson-White Syndrome

Amiodarone is an iodine-rich drug widely used for the management of various arrhythmias, but its clinical utility is usually limited by the high frequency of numerous side effects, most frequently disturbance of thyroid function.. The present study presents the laboratory tests, color flow Doppler sonography (CFDS) findings, treatment and prognosis of 22 patients with amiodarone-induced thyroid dysfunction.. Eleven patients developed amiodarone- induced thyrotoxicosis (AIT), ten developed amiodarone-induced hypothyroidism (AIH) and one patient first developed AIT, followed by AIH. Age, amiodarone doses, duration of amiodarone treatment and discontinuation of amiodarone were similar in the patients with AIT and AIH. AIT was found more commonly in male patients, AIH in female patients. Color flow Doppler sonographic examination was performed in all patients with AIT to differentiate type 1 and 2 AIT. In ten patients, CFDS demonstrated increased glandular vascularity, diagnostic for type 1 AIT.. This paper presents patients with AIT treated successfully with propylthiouracil or prednisolone after developing thyroid dysfunction as a consequence of amiodarone use. The role of thyroid Doppler in managing these patients is emphasized.

Topics: Adult; Aged; Amiodarone; Antithyroid Agents; Atrial Fibrillation; Diagnosis, Differential; Female; Humans; Hypothyroidism; Male; Middle Aged; Propylthiouracil; Tachycardia, Ventricular; Thyrotoxicosis; Ultrasonography, Doppler, Color

A 47-year-old man who smelled of alcohol presented with a three-day history of sore throat. He had not had fever, nausea, vomiting, diarrhea, rhinorrhea, cough, chest pain, or palpitations. On evaluation in the emergency department, he was found to have tachycardia and an irregular pulse.

Topics: Alcoholism; Antithyroid Agents; Atrial Fibrillation; Coxsackievirus Infections; Diagnosis, Differential; Electrocardiography; Graves Disease; Humans; Male; Middle Aged; Propylthiouracil; Thyroid Function Tests

Topics: Adrenal Cortex Hormones; Aspirin; Atrial Fibrillation; Diarrhea; Fever; Guanethidine; Humans; Iodides; Propranolol; Propylthiouracil; Psychoses, Substance-Induced; Reserpine; Stress, Physiological; Surgical Procedures, Operative; Sweating; Thyroid Crisis; Vitamin B Complex

Topics: Adolescent; Antithyroid Agents; Atrial Fibrillation; Digitalis Glycosides; Diuretics; Electrocardiography; Heart Auscultation; Heart Failure; Humans; Hyperthyroidism; Male; Mitral Valve Insufficiency; Propylthiouracil; Quinidine; Reserpine; Streptococcal Infections