Atrial fibrillation: low TSH levels increased the risk of developing AF.

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Atrial fibrillation: low TSH levels increased the risk of developing AF.

Clinical bottom line (level 1b)

1. Elderly patients with TSH levels < 0.1 mU/l were at increased risk of developing atrial fibrillation
(NNF = 6 for 10 years) .
Sawin et al: New England Journal of Medicine 1994; 331 (19): 1249-1252 Expires November 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an
independent set of patients.

Setting: community, USA

2007 patients (aged ?, 59% female) any patients

Excluded if
z <60 years old
z atrial fibrillation on entry or history of arrhythmias

z clinical hyperthyroidism

Factors studied:
z serum thyrotropin (TSH) level: low ( 0.1 mU/l or less)
z slightly low (>0.1 to 0.4 mU/l)

z high (>5.0 mU/l)

Multivariate model controlled for smoking, diabetes, hypertension, LVH, MI, CHF, and heart murmur.

100% followed for 10 years

Outcomes studied:
z developing AF

z Patients with a history of hyperthyroidism or who were on thyroid hormone preparation were not
excluded.

The evidence

%
outcome time to outcome number of patients/total number
(95% CI)

7.9%
developing AF 10 years 160/2007
(6.8% to 9.1%)

prognostic factor for adjusted RR NNF+

time to outcome
developing AF (95% CI) (95% CI)

serum thyrotropin (TSH) level: low ( 0.1 mU/l or less) 10 years 3.1 6

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(1.7 to 5.5) (3 to 18)

1.6 21
slightly low (>0.1 to 0.4 mU/l) 10 years
(1.0 to 2.5) (8 to infinity)

1.4 30
high (>5.0 mU/l) 10 years
(0.9 to 2.3) (-120 to 9)

z NNF calculated using normal TSH level group as control rate (>0.4 to 5.0 mU/l).
z 59% of patients in low TSH group were taking thyroxine. 84% of patients not taking thyroxine had a
normal serum thyroxine concentration.
z Only 15% of patients with low TSH and AF developed clinical hyperthyroidism.

Comments

1. No significant differences were noted when analysing the data with or without the population with
thyroid disease.

Citation

1. Sawin CT, Geller A, Wolf PA, et al: Low serum thyrotropin concentrations as a risk factor for atrial
fibrillation in older persons. New England Journal of Medicine 1994; 331 (19): 1249-1252

Contributor: Nick Shenker and Chris Ball, November 2000

Reviewer:

Clinical Question.

Patient patients

Intervention or Exposure TSH level

Outcome risk of developing AF

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http://www.eboncall.org/CATs/2640.htm 2/11/2011