• BMJ · Nov 2012

    Comparative Study

    The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study.

    • Christian Selmer, Jonas Bjerring Olesen, Morten Lock Hansen, Jesper Lindhardsen, Olsen Anne-Marie Schjerning AM, Jesper Clausager Madsen, Jens Faber, Peter Riis Hansen, Ole Dyg Pedersen, Christian Torp-Pedersen, and Gunnar Hilmar Gislason.
    • Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. cselmer@gmail.com
    • BMJ. 2012 Nov 27; 345: e7895.

    ObjectivesTo examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients.DesignPopulation based cohort study of general practice patients identified by linkage of nationwide registries at the individual level.SettingPrimary care patients in the city of Copenhagen.SubjectsRegistry data for 586,460 adults who had their thyroid function evaluated for the first time by their general practitioner during 2000-10 and who were without previously recorded thyroid disease or atrial fibrillation.Main Outcome MeasurePoisson regression models used to estimate risk of atrial fibrillation by thyroid function.ResultsOf the 586,460 individuals in the study population (mean (SD) age 50.2 (16.9) years, 39% men), 562,461 (96.0%) were euthyroid, 1670 (0.3%) had overt hypothyroidism, 12,087 (2.0%) had subclinical hypothyroidism, 3966 (0.7%) had overt hyperthyroidism, and 6276 (1.0%) had subclinical hyperthyroidism. Compared with the euthyroid individuals, the risk of atrial fibrillation increased with decreasing levels of thyroid stimulating hormone (TSH) from high normal euthyroidism (incidence rate ratio 1.12 (95% CI 1.03 to 1.21)) to subclinical hyperthyroidism with reduced TSH (1.16 (0.99 to 1.36)) and subclinical hyperthyroidism with supressed TSH (1.41 (1.25 to 1.59)). Both overt and subclinical hypothyroidism were associated with a lower risk of atrial fibrillation.ConclusionThe risk of atrial fibrillation was closely associated with thyroid activity, with a low risk in overt hypothyroidism, high risk in hyperthyroidism, and a TSH level dependent association with risk of atrial fibrillation across the spectrum of subclinical thyroid disease.

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