Remote patient monitoring can help patients with thyrotoxicosis. Thyrotoxicosis affects 1.2 percent of people in the United States, with 0.5 percent having overt thyrotoxicosis and 0.7 percent having subclinical thyrotoxicosis.[1] Many cardiovascular effects, including sinus tachycardia, systolic hypertension, alterations in ventricular systolic and diastolic function, and a tendency to dysrhythmias, including atrial fibrillation, result from thyrotoxicosis. The prevalent belief that thyrotoxicosis is a curable ailment with no long-term repercussions stems from the availability of efficient treatments, but emerging data suggests that this is not the case, particularly in terms of cardiovascular disease. So, what are the effects of thyrotoxicosis on the cardiovascular system?
Thyrotoxicosis and Ventricular Function
Hyperthyroidism is linked to increased heart contractility and improved diastolic function in the short term. But chronic thyrotoxicosis, on the other hand, causes left ventricular hypertrophy in the long run. Excess thyroid hormone has been related to increased cardiac protein synthesis, leading to the theory that cardiac hypertrophy compromises ventricular function.
Thyrotoxicosis and Arrhythmias
The most common arrhythmia linked with thyroid hormone excess is sinus tachycardia. Atrial premature contractions and atrial fibrillation are two more common rhythm abnormalities linked with thyrotoxicosis. Patients with paroxysmal atrial tachycardia or atrial flutter are less common. Premature ventricular contractions and ventricular tachyarrhythmias are uncommon. Thyroid hormones are thought to have direct effects on the conduction system, perhaps through cellular changes in cation transport, such as lowering the atrial excitation threshold, increasing sinoatrial node firing, and reducing conduction tissue refractory time, leading to arrhythmias.
Thyrotoxicosis and Heart Failure
Heart failure in thyrotoxicosis can be caused by a number of reasons. When hyperthyroidism’s hemodynamic changes are insufficient to satisfy the increased metabolic needs of peripheral tissue, or when the high-output condition or tachyarrhythmias exacerbate underlying coronary artery disease, heart failure can ensue. Diastolic function deteriorates as the disease progresses due to left ventricular dysfunction. Ventricular hypertrophy and stiffening, which impair ventricular filling, especially in the presence of tachycardia or atrial fibrillation, can also lead to heart failure. Thyrotoxicosis is also linked to an increase in total blood volume and plasma volume, which raises filling pressures even more. Reduced systemic resistance can sometimes overwhelm heart capacity, resulting in high-output failure. Heart failure is often precipitated by ischemia and the high-output condition, tachyarrhythmias, or both may expose coronary artery disease.
Thyrotoxicosis and Hypertension
The inadequacy of the vasculature to handle higher cardiac output and stroke volume may be the cause of isolated systolic hypertension. Thyroid hormones may directly cause smooth muscle cells in blood vessels to relax, which lowers the systemic vascular resistance.
So, how can remote patient monitoring help patients with thyrotoxicosis?
Monitoring physiological data is critical for assessing health, and access to physiological data is becoming increasingly relevant not only in clinical settings but also in outpatient settings. Accurate and precise self-monitoring technologies thus have the potential to benefit both the individual user and healthcare providers by providing real-time feedback on specific physiological characteristics. Routine ECG and 24-hour Holter monitoring including heart rate variability analysis as a noninvasive marker of autonomic function may assist in identifying those at high risk of thyrotoxicosis and can help manage the condition immediately.
Takeaway
Thyrotoxicosis is the clinical manifestation of a set of illnesses characterized by excessive thyroid hormone action at the tissue level and is caused by excessive thyroid hormone concentrations. It affects a significant number of individuals and has several cardiovascular effects. Remote patient monitoring is critical in these cases because it provides continuous monitoring and allows healthcare professionals to intervene quickly.
References:
- Tunbridge W, Evered D, Hall R 1977 The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol 7:481–493
