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  • Author: Grigoris Effraimidis x
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Georgios Kostopoulos Department of Endocrinology and Metabolism, Ippokratio General Hospital of Thessaloniki, Greece

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Grigoris Effraimidis Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

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Atrial fibrillation (AF) is a common condition with a global estimated prevalence of 60 million cases, and the most common cardiac complication of hyperthyroidism, occurring in 5–15% of overtly hyperthyroid patients. Additionally, subclinical hyperthyroidism and high-normal free T4 have been associated with an increased risk in the development of AF. Hyperthyroidism-related AF is a reversible cause of AF, and the majority of patients spontaneously revert to sinus rhythm in 4–6 months during or after restoration of euthyroidism. Therefore, restoring thyroid function is an indispensable element in hyperthyroidism-related AF management. Rate control with beta-blockers consists another first-line therapy, reserving rhythm control in cases of persistent hyperthyroidism-related AF. It is still controversial whether hyperthyroidism is an independent risk factor of stroke in nonvalvular AF. As a result, initiating anticoagulation should be guided by the clinical thromboembolic risk score CHA2DS2-VASc score in the same way it is applied in patients with non-hyperthyroidism-related AF. Treatment with the novel direct oral anticoagulants appears to be as beneficial and may be safer than warfarin in patients with hyperthyroidism-related AF. In this review, we address the epidemiology, prognosis, and diagnosis of hyperthyroidism-related AF, and we discuss the management strategies and controversies in patients with hyperthyroidism-related AF.

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Grigoris Effraimidis Departments of Endocrinology and Metabolism, University of Amsterdam, Amsterdam, The Netherlands

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Jan G.P. Tijssen Departments of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

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Wilmar M. Wiersinga Departments of Endocrinology and Metabolism, University of Amsterdam, Amsterdam, The Netherlands

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Background: Alcohol consumption has been identified as a protective factor for some autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus. Objective: We hypothesized that alcohol consumption would reduce the risk of developing autoimmune thyroid disease (AITD). Study design: Two nested case-control studies in the prospective Amsterdam AITD cohort. Follow-up was 5 years, with annual assessments. In study A, we compared alcohol consumption between cases (subjects who during follow-up remained euthyroid but developed thyroid peroxidase antibodies (TPO-Ab), called event) and controls (subjects who remained euthyroid and TPO-Ab-negative). In study B, we compared alcohol consumption between cases (subjects who during follow-up developed overt hypothyroidism, called event) and controls (subjects who did not develop overt hypothyroidism). For each case, 2 controls were selected, matched for age, duration of follow-up and smoking behavior at baseline and at the time of event. Results: In study A, alcohol consumption did not differ between cases and controls at any time point. In study B, the number of subjects consuming >10 units of alcohol per week was not different between cases and controls at study entrance (8.3 vs. 14.5%, NS), but lower at 1 year before (5.3 vs. 19.7%, p = 0.041) and at the time of event (6.7 vs. 23.7%, p = 0.044); respective odds ratios are 0.54 (0.14–2.06), 0.23 (0.05–1.04) and 0.23 (0.05–1.06). Conclusion: Alcohol consumption is not associated with de novo development of TPO-Ab, but is lower in subjects who developed overt hypothyroidism. The data suggest alcohol consumption may protect against overt autoimmune hypothyroidism.

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