School of Medical Sciences, Pontifical Catholic University of Campinas, Campinas-SP, Brazil.
Endocrinology Division, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas-SP, Brazil.
Endocr Pract. 2024 Sep;30(9):822-829. doi: 10.1016/j.eprac.2024.05.010. Epub 2024 May 20.
Hypermetabolic state in Graves' disease (GD) has a great impact on heart homeostasis, acting directly on the heart muscle and modulating the autonomic nervous system. To characterize cardiac autonomic neuropathy (CAN) as a possible complication in patients with GD.
We evaluated euthyroid GD patients and a control group of healthy euthyroid people. CAN was assessed using autonomic tests of cardiovascular reflex and heart rate variability: respiratory, Valsalva, orthostatic and orthostatic hypotension tests, high frequency, low frequency, and very low-frequency bands. Transthoracic echocardiography was performed in GD patients.
Sixty GD patients and 50 people in control group were assessed. CAN was diagnosed in 20% of GD and 14% in the control group. Among GD, 13.3% presented incipient, and 6.7% established CAN, while in the control group, it was verified incipient in 8% and established in 6% (P = .7479). All GD patients with CAN presented an alteration in the deep breathing test. Age and smoking were evidenced as factors associated with the presence of CAN, while higher TRAb values at diagnosis decreased the chance of CAN.
The prevalence of CAN in euthyroid GD patients was 20%. Changes in the cardiac autonomic nervous system were identified, pointing to the importance of evaluating this complication in these patients. Smoking was a predictive factor for CAN, increasing its relationship with conditions that aggravate GD.
格雷夫斯病（GD）的高代谢状态对心脏稳态有很大影响，直接作用于心肌并调节自主神经系统。将心脏自主神经病变（CAN）作为 GD 患者的一种可能并发症进行特征描述。
我们评估了甲状腺功能正常的 GD 患者和一组健康的甲状腺功能正常的对照组。使用心血管反射和心率变异性的自主神经测试来评估 CAN：呼吸、瓦尔萨尔瓦、直立和直立性低血压测试、高频、低频和极低频带。对 GD 患者进行经胸超声心动图检查。
共评估了 60 名 GD 患者和 50 名对照组。在 GD 组中诊断出 20%的 CAN，在对照组中诊断出 14%。在 GD 中，13.3%出现初期 CAN，6.7%出现已确立的 CAN，而在对照组中，分别有 8%和 6%出现初期 CAN 和已确立的 CAN（P=0.7479）。所有患有 CAN 的 GD 患者均存在深呼吸测试异常。年龄和吸烟被证明是与 CAN 存在相关的因素，而诊断时更高的 TRAb 值降低了 CAN 的可能性。
甲状腺功能正常的 GD 患者中，CAN 的患病率为 20%。识别出心脏自主神经系统的变化，这表明在这些患者中评估这种并发症的重要性。吸烟是 CAN 的预测因素，增加了与加重 GD 的情况的关系。
