Division of Endocrinology and Metabolism, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
Front Endocrinol (Lausanne). 2022 Nov 1;13:1032764. doi: 10.3389/fendo.2022.1032764. eCollection 2022.
Atrial fibrillation (AF) is occasionally diagnosed in individuals with Graves' disease. Definite treatments, including radioactive iodine therapy (RAIT) or surgery might lower the risk of AF in the literature. However, no studies have compared the effects of anti-thyroid drugs (ATDs), RAIT, and surgery on the risk of AF.
This retrospective cohort study included 94,060 newly diagnosed Graves' disease patients and 470,300 controls from the Korean National Health Insurance database. The incidence of AF was evaluated in patients and controls. Patients were categorized based on treatment method into ATD (95.6%), RAIT (3.5%), and surgery (0.9%) groups. In the ATD group, the dose and duration of ATDs were calculated for each patient. In the RAIT and surgery groups, remission was defined as levothyroxine prescription.
Graves' disease patients had a 2.2-fold higher risk of developing AF than controls. Regardless of demographic factors, the patient group had a consistently higher risk of AF than controls, with the highest risk of AF (HR, 5.49) in the younger patient group. The surgery group had a similar risk of AF compared with controls, whereas the ATD (HR, 2.23) and RAIT (HR, 2.00) groups had increased risks of AF, even in patients reaching hypothyroid status after RAIT. Patients with higher dose or longer treatment duration of ATDs were at greater risk of AF.
We observed differing risks of AF according to methods of treatment for Graves' disease, and that definite treatment can be an option for subjects needing sustained medical treatment considering the risk of AF.
心房颤动（AF）偶尔在格雷夫斯病患者中被诊断出来。放射性碘治疗（RAIT）或手术等确定性治疗可能会降低文献中 AF 的风险。然而，尚无研究比较抗甲状腺药物（ATD）、RAIT 和手术对 AF 风险的影响。
本回顾性队列研究纳入了 94060 例新诊断的格雷夫斯病患者和 470300 例对照，数据来自韩国国家健康保险数据库。评估了患者和对照者中 AF 的发生率。根据治疗方法，患者分为 ATD（95.6%）、RAIT（3.5%）和手术（0.9%）组。在 ATD 组中，计算了每位患者的 ATD 剂量和疗程。在 RAIT 和手术组中，缓解定义为左甲状腺素的处方。
格雷夫斯病患者发生 AF 的风险是对照组的 2.2 倍。无论人口统计学因素如何，患者组发生 AF 的风险始终高于对照组，年轻患者组的 AF 风险最高（HR，5.49）。与对照组相比，手术组发生 AF 的风险相似，而 ATD（HR，2.23）和 RAIT（HR，2.00）组即使在 RAIT 后达到甲状腺功能减退状态的患者中，也存在更高的 AF 风险。ATD 剂量更高或治疗时间更长的患者发生 AF 的风险更高。
我们观察到根据格雷夫斯病的治疗方法，AF 的风险不同，对于需要持续药物治疗的患者，确定性治疗可能是一种选择，需要考虑 AF 的风险。
