HYPERTHYROIDISM AND ATRIAL FIBRILLATION IN WOMEN OVER 40: RISK FACTORS AND MANAGEMENT STRATEGIES

Аннотация

Hyperthyroidism, characterized by excessive thyroid hormone production, is a well-established risk factor for atrial fibrillation (AF), particularly in women over 40. This article reviews the pathophysiological mechanisms, epidemiological data, and evidence-based management approaches for AF in hyperthyroid patients, with a focus on middle-aged and older women. We analyze key studies and clinical guidelines to provide a comprehensive overview of this critical cardiovascular-endocrine interaction. Keywords: Hyperthyroidism, Atrial fibrillation, Thyrotoxic arrhythmia, Women cardiovascular health, Middle-aged women, Subclinical hyperthyroidism, CHA₂DS₂-VASc score, Thyroid hormone cardiac effects, Anticoagulation in hyperthyroidism, Graves’ disease and AF Аннотация: Гипертиреоз, характеризующийся избыточной выработкой гормонов щитовидной железы, является общепризнанным фактором риска фибрилляции предсердий (ФП), особенно у женщин старше 40 лет. В этой статье рассматриваются патофизиологические механизмы, эпидемиологические данные и научно обоснованные подходы к лечению ФП у пациентов с гипертиреозом с акцентом на женщин среднего и пожилого 20 Journаl of Аnаlyticаl Synergy аnd Scientific Horizon ISSN: 3060-5261 Impact faktor: 9.9 Volume 1, Issue 3, Series C 2025 возраста. Мы анализируем ключевые исследования и клинические рекомендации, чтобы предоставить всесторонний обзор этого критического сердечно-сосудистого и эндокринного взаимодействия. Ключевые слова: Гипертиреоз, Фибрилляция предсердий, Тиреотоксическая аритмия, Здоровье сердечно-сосудистой системы у женщин, Женщины среднего возраста, Субклинический гипертиреоз, Оценка CHA₂DS₂-VASc, Влияние гормонов щитовидной железы на сердце, Антикоагуляция при гипертиреозе, Болезнь Грейвса и ФП Annotatsiya: Qalqonsimon bez gormonlarining haddan tashqari ko'p ishlab chiqarilishi bilan tavsiflangan gipertiroidizm, ayniqsa 40 yoshdan oshgan ayollarda atriyal fibrilatsiya (AF) uchun yaxshi tasdiqlangan xavf omilidir. Ushbu maqolada gipertiroidi bilan og'rigan bemorlarda AF uchun patofizyologik mexanizmlar, epidemiologik ma'lumotlar va dalillarga asoslangan davolash yondashuvlari ko'rib chiqiladi, asosiy e'tibor o'rta va keksa ayollarga qaratilgan. Biz ushbu muhim yurak- qon tomir va endokrin o'zaro ta'sirining keng qamrovini ta'minlash uchun asosiy tadqiqotlar va klinik ko'rsatmalarni tahlil qilamiz. Kalit so'zlar: Gipertiroidizm, Atriyal fibrilatsiya, Tirotoksik aritmiya, Ayollarning yurak-qon tomir salomatligi, O'rta yoshli ayollar, Subklinik hipertiroidizm, CHA₂DS₂-VASc skori, Qalqonsimon gormonning yurak ta'siri, Gipertiroidizmda antikoagulyatsiya, Graves kasalligi va AF. Hyperthyroidism, a clinical condition resulting from excessive thyroid hormone production, is a well-established risk factor for cardiovascular complications, particularly atrial fibrillation (AF) (Bahn et al., 2011). The interplay between thyroid dysfunction and cardiac arrhythmias has been extensively studied, 21 Journаl of Аnаlyticаl Synergy аnd Scientific Horizon ISSN: 3060-5261 Impact faktor: 9.9 Volume 1, Issue 3, Series C 2025 with growing evidence suggesting that women over 40 years of age are disproportionately affected due to hormonal fluctuations, increased autoimmune susceptibility, and age-related cardiovascular changes (Selmer et al., 2012). Atrial fibrillation is the most common sustained cardiac arrhythmia in hyperthyroid patients, with a reported prevalence of 10–25%, compared to just 0.4– 1% in the general population (Frost et al., 2004). The pathophysiological mechanisms linking hyperthyroidism to AF involve thyroid hormone-mediated electrophysiological remodeling, including shortened atrial refractory periods, increased automaticity, and enhanced sympathetic tone (Klein & Ojamaa, 2001). Additionally, subclinical hyperthyroidism (low TSH with normal free T4/T3) has been associated with a 2–3-fold increased risk of AF, emphasizing the need for early detection and intervention (Sawin et al., 1994). Women over 40 represent a high-risk demographic due to several factors: 1. Higher prevalence of autoimmune thyroid disorders (e.g., Graves’ disease) compared to men (Hollowell et al., 2002). 2. Age-related structural heart changes (e.g., atrial fibrosis) that predispose to arrhythmias (Gammage et al., 2007). 3. Estrogen’s modulatory effects on thyroid hormone metabolism, which may exacerbate arrhythmogenesis (Osman et al., 2007). The clinical implications are significant—AF in hyperthyroid patients is associated with higher thromboembolic stroke risk (CHA₂DS₂-VASc ≥2 in most cases) and increased cardiovascular mortality (January et al., 2019). Despite this, optimal management strategies remain debated, particularly regarding: 22 Journаl of Аnаlyticаl Synergy аnd Scientific Horizon ISSN: 3060-5261 Impact faktor: 9.9 Volume 1, Issue 3, Series C 2025 • Antithyroid therapy (thionamides vs. radioiodine) and its impact on AF reversibility. • Rate vs. rhythm control in thyrotoxic AF. • Anticoagul