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Angiology
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Occult Thyrotoxicosis in Patients with Atrial Fibrillation and an Acute Arterial Embolism

M. Monreal

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

E. Lafoz

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

M. Foz

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

A. Sanmarti

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

I. Salinas

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

L. Audi

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

E. Viver

Departments of Medicine, Surgery, and Biochemistry, Hospital de Badalona "Germans Trias i Pujol," Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

Serum total thyroxine, triiodothyronine, and thyrotropin response to thyro tropin-releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial fibrillation: 33 patients with an acute arterial limb embolism (Group I), 31 patients with an acute embolic stroke (Group II), and 62 patients without any arterial occlusion (Group III). A blunted TRH-TSH test, suggestive of thyrotoxicosis, was found in 5 patients in Group I, 8 patients in Group II, and 2 patients in Group III. The diagnosis of hyperthyroidism was confirmed in 8 patients (by repeated TRH-TSH test and scintigraphy): 4 pa tients in Group I (12.1%) and 4 patients in Group II (12.9%). All of them had a nonvalvular atrial fibrillation. Thyrotoxicosis should not be recognized in 6 of them if TRH-TSH test was not performed, because peripheral hormone levels were normal. Five of these 8 patients with thyrotoxicosis had reversion to sinus rhythm after treatment with carbimazole, either spontaneously or after car dioversion. This outcome prevented prolongation of anticoagulant therapy for an indefinite time.

Angiology, Vol. 39, No. 11, 981-985 (1988)
DOI: 10.1177/000331978803901108
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