The American journal of the medical sciences
June 24, 2026 · via Europe PMC
Association between reverse triiodothyronine and cardiac complications in patients with uncontrolled Graves' disease.
Feng X, Hu Y, Yan S, Liu F, Wang Y.
AI summary — for doctors, generated from the abstract only
A cross-sectional study of hospitalized Graves' disease patients found that higher serum reverse triiodothyronine levels were strongly and consistently associated with increased risk of atrial fibrillation and heart failure related to uncontrolled thyrotoxicosis.
What was studied
A cross-sectional study of 178 hospitalized patients with uncontrolled Graves' disease (2016-2020) using Hospital Inpatient Sample database data, examining the association between serum reverse triiodothyronine (rT3) levels and cardiac complications (atrial fibrillation, heart failure) directly attributable to thyrotoxicosis, using restricted cubic splines and multivariate logistic regression adjusted for confounders.
Key findings
- Among 178 patients, 94 (54.0%) had cardiac complications; a linear dose-response relationship was found between serum rT3 concentration and cardiac complications after adjustment for age, sex, duration of hyperthyroidism, diabetes, hypertension, and laboratory parameters.
- For each 1 nmol/L increase in rT3, the odds of cardiac complications rose by 65% (OR 1.65, 95% CI 1.28-2.14), described as statistically significant (exact p-value not available in the provided abstract text, which appears truncated).
Clinical relevance
This may be relevant to endocrinologists and internists managing uncontrolled Graves' disease, suggesting serum rT3 could serve as a robust biomarker to identify patients at higher risk for atrial fibrillation and heart failure, potentially supporting more intensive monitoring or treatment in those with elevated levels.
Who should care
Limitations
Cross-sectional design cannot establish causal direction between rT3 levels and cardiac complications; reliance on an inpatient sample database may introduce selection bias toward more severely affected patients.
Higher reverse T3 levels were strongly linked to a greater risk of atrial fibrillation and heart failure in uncontrolled Graves' disease, suggesting this biomarker could help identify patients needing closer cardiac monitoring.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Cardiac complications associated with poorly controlled Graves' disease present a significant challenge in managing hyperthyroid patients. The relationship between thyrotoxicosis severity and cardiac complications remains to be confirmed. This study investigates the association between reverse triiodothyronine (rT3) and cardiac complications in hospitalized patients with uncontrolled Graves' disease.
Methods
This cross-sectional study evaluated 178 hospitalized patients with uncontrolled Graves' disease from 2016 to 2020. After excluding cardiac diseases unrelated to Graves' disease, atrial fibrillation and heart failure were identified as direct outcomes of uncontrolled thyrotoxicosis. Data were extracted from the Hospital Inpatient Sample database, including demographic information, disease duration, comorbidities, and serum thyroid hormone levels. Restricted cubic splines and multivariate logistic regression models were used to assess the association between serum rT3 levels and cardiac complications related to thyrotoxicosis.
Results
Among the 178 patients, 94 (54.0%) had cardiac complications. Multivariable logistic regression models adjusted for potential confounders (age, sex, duration of hyperthyroidism, diabetes, hypertension, and laboratory parameters) demonstrated a linear dose-response relationship between serum rT3 concentrations and cardiac complications. For each 1 nmol/L increase in rT3, the odds of cardiac complications rose by 65% (OR 1.65, 95% CI 1.28-2.14; P < 0.001). Subgroup analyses stratified by median age (50 years), median disease duration (12 months), sex, and anemia status showed that this association was consistent across all subgroups.
Conclusions
Elevated serum rT3 is a robust biomarker for atrial fibrillation and heart failure in uncontrolled Graves' disease and associates with greater hyperthyroidism severity and related cardiac complications.
DOI
10.1016/j.amjms.2026.06.020
PMID
42342032
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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