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- Title
MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy.
- Authors
Peng, Carol Chiung-Hui; Lin, Yu-Jie; Lee, Sun Y.; Lin, Shu-Man; Han, Cheng; Loh, Ching-Hui; Huang, Huei-Kai; Pearce, Elizabeth N.
- Abstract
This cohort study investigates the association of antithyroid drug, radioactive iodine, and surgery treatments with major adverse cardiovascular events in patients with newly diagnosed hypothyroidism. Key Points: Question: What are the long-term major adverse cardiovascular events (MACE) and all-cause mortality outcomes comparing the use of antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism? Findings: In this cohort study of 114 062 patients with newly diagnosed hyperthyroidism, surgery was associated with a 24% lower risk of MACE and 47% lower risk of all-cause mortality, while RAI was associated with a 55% lower risk of MACE compared with ATDs. Meaning: These findings suggest that surgery or RAI may be better treatment options than long-term ATD use in patients with hyperthyroidism who are at risk of MACE. Importance: Excessive thyroid hormones from hyperthyroidism increase cardiovascular risks. Among 3 available treatments for hyperthyroidism, comparisons of long-term outcomes associated with antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism are lacking. Objective: To compare risks of major adverse cardiovascular events (MACE) and all-cause mortality among patients with hyperthyroidism treated with ATDs, RAI, or surgery. Design, Setting, and Participants: This nationwide cohort study used the Taiwan National Health Insurance Research Database. Patients aged 20 years or older with newly diagnosed hyperthyroidism between 2011 and 2020 were enrolled. Treatment groups were determined within 18 months from diagnosis, with follow-up until the development of MACE, death, or the end date of the database, whichever came first. Data were analyzed from October 2022 through December 2023. Exposures: The ATD group received ATDs only. RAI and surgery groups could receive ATDs before treatment. Anyone who underwent thyroid surgery without RAI was classified into the surgery group and vice versa. Main Outcomes and Measures: The primary outcomes included MACE (a composite outcome of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality. Results: Among 114 062 patients with newly diagnosed hyperthyroidism (mean [SD] age, 44.1 [13.6] years; 83 505 female [73.2%]), 107 052 patients (93.9%) received ATDs alone, 1238 patients (1.1%) received RAI, and 5772 patients (5.1%) underwent surgery during a mean (SD) follow-up of 4.4 (2.5) years. Patients undergoing surgery had a significantly lower risk of MACE (hazard ratio [HR] = 0.76; 95% CI, 0.59-0.98; P =.04), all-cause mortality (HR = 0.53; 95% CI, 0.41-0.68; P <.001), heart failure (HR = 0.33; 95% CI, 0.18-0.59; P <.001), and cardiovascular mortality (HR = 0.45; 95% CI, 0.26-0.79; P =.005) compared with patients receiving ATDs. Compared with ATDs, RAI was associated with lower MACE risk (HR = 0.45; 95% CI, 0.22-0.93; P =.03). Risks for acute myocardial infarction and stroke did not significantly differ between treatment groups. Conclusions and Relevance: In this study, surgery was associated with lower long-term risks of MACE and all-cause mortality, while RAI was associated with a lower MACE risk compared with ATDs.
- Subjects
TAIWAN; MORTALITY prevention; HYPERTHYROIDISM treatment; HYPERTHYROIDISM diagnosis; RISK assessment; IODINE radioisotopes; RESEARCH funding; ACADEMIC medical centers; STATISTICAL hypothesis testing; MAJOR adverse cardiovascular events; SCIENTIFIC observation; LOGISTIC regression analysis; PROBABILITY theory; DESCRIPTIVE statistics; AGE distribution; THYROID antagonists; KAPLAN-Meier estimator; LOG-rank test; ODDS ratio; LONGITUDINAL method; SURVEYS; HYPERTHYROIDISM; DISEASE relapse; DATA analysis software; CONFIDENCE intervals; COMORBIDITY; PROPORTIONAL hazards models; DISEASE risk factors; DISEASE complications
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe240904
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.0904