Cardiac Manifestations of Graves Disease in a Tertiary Care Hospital

Background: Graves’ disease is the most common cause of hyperthyroidism and is associated with various cardiovascular complications due to excessive thyroid hormone activity. Cardiac manifestations range from sinus tachycardia and atrial fibrillation to structural and functional cardiac abnormalities. Early recognition and appropriate treatment are essential to prevent complications and improve clinical outcomes. Aim: To study the cardiac manifestations of Graves’ disease in a tertiary care hospital, evaluate the different treatment modalities, and assess treatment outcomes in terms of achievement of euthyroid or hypothyroid states and disease relapse. Materials and Methods: An observational study was conducted over two years in the Department of General Medicine in collaboration with Biochemistry, Nuclear Medicine, and General Surgery. A total of 110 patients aged above 18 years with biochemically confirmed thyrotoxicosis and scintigraphically diagnosed Graves’ disease were included. Patients with non-Graves’ thyrotoxicosis, pregnancy, or beta-blocker use were excluded. Clinical manifestations, thyroid function tests, electrocardiographic findings, and echocardiographic parameters were evaluated. Treatment modalities included antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and surgery. Treatment outcomes were assessed during follow-up. Results: The majority of patients belonged to the 40–59-year age group, with a female predominance. Weight loss (79.0%) and palpitations (72.7%) were the most common symptoms. Tremor (56.3%), tachycardia (45.4%), and warm, moist skin (49.0%) were the predominant clinical findings. Electrocardiography revealed sinus tachycardia in 45.4%, atrial fibrillation in 11.8%, and ST/T changes in 19.1% of patients. Among patients with atrial fibrillation, echocardiography revealed pulmonary arterial hypertension in 84.6% and moderate-to-severe tricuspid regurgitation in 69.2%. Of 104 treated patients, 47 received ATD, 54 underwent RAI therapy, and 3 underwent surgery. Among 45 patients followed up, 17 of 24 patients in the RAI group developed hypothyroidism by the third month. Five patients with atrial fibrillation reverted to sinus rhythm following treatment. Conclusion: Graves’ disease is associated with significant cardiac manifestations, particularly sinus tachycardia and atrial fibrillation. Early diagnosis, cardiac evaluation, and appropriate treatment are essential. RAI therapy was associated with a higher frequency of early hypothyroidism, emphasizing the need for regular thyroid function monitoring. Keywords: Graves’ disease; Cardiac manifestations; Atrial fibrillation; Radioactive iodine therapy