Hussein Mohammad, Toraih Eman, Reisner Adin S C, Miller Peter, Corsetti Ralph, Kandil Emad
Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Gland Surg. 2021 Sep;10(9):2608-2621. doi: 10.21037/gs-21-236.
Little is known about the implications of hyperthyroidism on cardiovascular diseases like myocardial infarctions (MI), ischemic strokes, and hemorrhagic strokes. Previous studies implicate hyperthyroidism as a risk factor for MI and ischemic stroke. Cardiovascular disease is the leading cause of death in the US, and the possibility of hyperthyroidism contributing to this disease burden warrants investigation in a US patient population.
The National Readmission Database (NRD) from 2010 to 2017 was used to identify adults who had a new-onset diagnosis of MI, ischemic stroke, or hemorrhagic stroke. Risk factors for mortality, prolonged hospital stay, and hospital cost were analyzed with binary logistic regression.
A total of 278,609,748 hospital records were reviewed. Of these, 15,685,461 were hospitalized for adverse cardiovascular events with concomitant hyperthyroidism, roughly 4.5 per 1,000 cases. Patients with MI and hemorrhagic stroke with thyrotoxicosis had a lower mortality rate than euthyroid patients (OR 0.81, 95% CI: 0.78-0.84, P<0.001 and OR 0.72, 95% CI: 0.67-0.77, P<0.001, respectively). Thyrotoxicosis was associated with increased hospital stay (MI: OR 1.35, 95% CI: 1.32-1.38, P<0.001; ischemic: OR 1.38, 95% CI: 1.35-1.41, P<0.001; hemorrhagic: OR 1.33, 95% CI: 1.25-1.40, P<0.001), expenditures in ischemic (OR 1.31, 95% CI: 1.28-1.34, P<0.001) and hemorrhagic stroke patients (OR 1.18, 95% CI: 1.12-1.24, P<0.001).
Patients that experienced MI or hemorrhagic stroke with concomitant thyrotoxicosis were observed to have a lower mortality rate than euthyroid patients but had with an increased length of hospital stay. Patients who had ischemic or hemorrhagic stroke with thyrotoxicosis had a significantly higher hospital cost. The hyperdynamic state underlying hyperthyroidism may be protective in these adverse events. Further studies into these physiological changes are warranted.
关于甲状腺功能亢进对心血管疾病如心肌梗死（MI）、缺血性卒中和出血性卒中的影响，人们了解甚少。先前的研究表明甲状腺功能亢进是心肌梗死和缺血性卒中的危险因素。心血管疾病是美国的主要死因，甲状腺功能亢进导致这种疾病负担的可能性值得在美国患者群体中进行调查。
使用2010年至2017年的国家再入院数据库（NRD）来识别首次诊断为心肌梗死、缺血性卒中或出血性卒中的成年人。通过二元逻辑回归分析死亡率、住院时间延长和医院费用的危险因素。
共审查了278,609,748份医院记录。其中，15,685,461人因心血管不良事件合并甲状腺功能亢进住院，每1000例中约有4.5例。患有甲状腺毒症的心肌梗死和出血性卒中患者的死亡率低于甲状腺功能正常的患者（OR分别为0.81，95%CI：0.78 - 0.84，P<0.001和OR 0.72，95%CI：0.67 - 0.77，P<0.001）。甲状腺毒症与住院时间延长相关（心肌梗死：OR 1.35，95%CI：1.32 - 1.38，P<0.001；缺血性：OR 1.38，95%CI：1.35 - 1.41，P<0.001；出血性：OR 1.33，95%CI：1.25 - 1.40，P<0.001），缺血性（OR 1.31，95%CI：1.28 - 1.34，P<0.001）和出血性卒中患者的费用支出增加（OR 1.18，95%CI：1.12 - 1.24，P<0.001）。
观察到患有心肌梗死或出血性卒中并伴有甲状腺毒症的患者死亡率低于甲状腺功能正常的患者，但住院时间延长。患有甲状腺毒症的缺血性或出血性卒中患者的医院费用显著更高。甲状腺功能亢进潜在的高动力状态在这些不良事件中可能具有保护作用。有必要对这些生理变化进行进一步研究。
