He YL, Xu WX, Fang TY, Zeng M. Hyperthyroidism and severe bradycardia: Report of three cases and review of the literature. World J Clin Cases 2023; 11(7): 1549-1559 [PMID: 36926388 DOI: 10.12998/wjcc.v11.i7.1549]
Corresponding Author of This Article
Min Zeng, PhD, Chief Doctor, Professor, Center of Geriatrics, Hainan General Hospital, No. 19 Xiuhua Road, Haikou 570311, Hainan Province, China. hndzm6@126.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2023; 11(7): 1549-1559 Published online Mar 6, 2023. doi: 10.12998/wjcc.v11.i7.1549
Hyperthyroidism and severe bradycardia: Report of three cases and review of the literature
Yang-Li He, Wen-Xing Xu, Tuan-Yu Fang, Min Zeng
Yang-Li He, Wen-Xing Xu, Min Zeng, Center of Geriatrics, Hainan General Hospital, Haikou 570311, Hainan Province, China
Yang-Li He, Wen-Xing Xu, Min Zeng, Hainan Clinical Research Center for Cardiovascular Disease, Hainan General Hospital, Haikou 570311, Hainan Province, China
Yang-Li He, Min Zeng, Center of Geriatrics, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
Tuan-Yu Fang, Department of Endocrine, Hainan General Hospital, Haikou 570311, Hainan Province, China
Author contributions: He YL and Zeng M contributed to manuscript writing and editing, and data collection; Xu WX and Fang TY contributed to data analysis; all authors have read and approved the final manuscript.
Supported bythe Clinical Medical Research Center Project of Hainan Province, China, No. LCYX202207; and Key R&D Plan Project of Hainan Province, China, No. ZDYF2020118.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Zeng, PhD, Chief Doctor, Professor, Center of Geriatrics, Hainan General Hospital, No. 19 Xiuhua Road, Haikou 570311, Hainan Province, China. hndzm6@126.com
Received: October 19, 2022 Peer-review started: October 19, 2022 First decision: December 26, 2022 Revised: January 13, 2023 Accepted: February 15, 2023 Article in press: February 15, 2023 Published online: March 6, 2023
Abstract
BACKGROUND
Hyperthyroidism often leads to tachycardia, but there are also sporadic reports of hyperthyroidism with severe bradycardia, such as sick sinus syndrome (SSS) and atrioventricular block. These disorders are a challenge for clinicians.
CASE SUMMARY
We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search. Through the analysis of these 34 cases, we found 21 cases of atrioventricular block and 13 cases of SSS, with 67.6% of the patients experiencing bradycardia symptoms. After drug treatment, temporary pacemaker implantation, or anti-hyperthyroidism treatment, the bradycardia of 27 patients (79.4%) was relieved, and the median recovery time was 5.5 (2-8) d. Only 7 cases (20.6%) needed permanent pacemaker implantation.
CONCLUSION
Patients with hyperthyroidism should be aware of the risk of severe bradycardia. In most cases, drug treatment or temporary pacemaker placement is recommended for initial treatment. If the bradycardia does not improve after 1 wk, a permanent pacemaker should be implanted.
Core Tip: Severe bradycardia, such as sick sinus syndrome and atrioventricular block, can occasionally be encountered in patients with hyperthyroidism. These pose a challenge for physicians. We report three cases of hyperthyroidism with severe bradycardia and identified an additional 31 cases indexed in PubMed. We found that hyperthyroidism with severe bradycardia may require 1 wk of observation before deciding whether to implant a permanent pacemaker. The use of drugs (e.g., atropine, isoproterenol, and/or anti-hyperthyroidism treatment), implantation of temporary pacemakers, and correcting the electrolyte disorder are recommended before permanent pacemaker implantation.
