Right heart function in Graves' disease

What is it about?

This is a longitudinal observational case series study investigating the effect of standard medical treatment of Graves’ thyrotoxicosis using carbimazole, with or without beta blockers, on cardiac function as measured by transthoracic echocardiography, exercise capacity and quality of life at three time points. The aim of this study was to evaluate the change in right heart function in individuals with Graves’ disease using transthoracic echocardiography at baseline in the hyperthyroid state, during the early phase of treatment and on restoration of euthyroidism. The interpretation of our findings is that Graves’ hyperthyroidism results in a hyperdynamic right ventricular functional state which then normalises with adequate treatment and restoration of euthyroidism.

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Why is it important?

There was a paucity of longitudinal data regarding right ventricular function in cases with Graves’ disease. There are no previous longitudinal studies comparing echo measurements within two weeks of anti-thyroid drug commencement, and no previous studies examining right ventricular echo measurements in hyperthyroid individuals with normal LV function. Right ventricular free wall longitudinal strain, excluding the interventricular septum, has prognostic value in various disease states. It could be speculated that the thin right ventricular free wall is more susceptible to damage than the thicker septum and left ventricle. A hyperdynamic right ventricle due to Graves' hyperthyroidism may be more susceptible to failure, particularly in patients who are older, with higher titre of TSH receptor antibodies, and with underlying heart disease.

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