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Review Article Volume 19 Issue 3
Cardiovascular involvement in hyperthyroidism: from pathophysiology to clinical management
Muharrem Özden, Berkant Bebek, Abdullah Sarihan, Mehmet Murat Şahin, Mehmet Mustafa Yilmaz, Muhammet Cihat Çelik, Mucahit Yetim, Macit Kalçik, Lütfü Bekar, Yusuf Karavelioğlu
Received: August 05, 2026 | Published: August 21, 2026
Citation: Özden M, Bebek B, Sarihan A, et al. Cardiovascular involvement in hyperthyroidism: from pathophysiology to clinical management. J Cardiol Curr Res. 2026;19(3):84-96. DOI: 10.15406/jccr.2026.19.00649
Abstract
Hyperthyroidism exerts substantial effects on the cardiovascular system through the combined actions of thyroid hormones on myocardial contractility, cardiac electrophysiology, vascular tone, and circulatory volume. These effects produce a characteristic hyperdynamic state characterized by increased heart rate, enhanced cardiac output, expanded blood volume, and reduced systemic vascular resistance. With sustained thyroid hormone excess, however, these initially adaptive responses may contribute to clinically relevant cardiovascular complications, including atrial fibrillation, heart failure, thyrotoxic cardiomyopathy, pulmonary hypertension, functional valvular abnormalities, and myocardial ischemia. Atrial fibrillation represents one of the most frequent and clinically important manifestations and may resolve after restoration of euthyroidism, although persistent arrhythmia can occur in patients with an underlying atrial substrate. Similarly, heart failure encompasses a spectrum ranging from highoutput failure with preserved systolic function to severe, potentially reversible ventricular dysfunction associated with thyrotoxic cardiomyopathy. Pulmonary hypertension and right ventricular abnormalities are also increasingly recognized and frequently improve following normalization of thyroid function. Cardiovascular involvement may additionally occur in subclinical hyperthyroidism, particularly when thyroid-stimulating hormone concentrations are markedly suppressed. Clinical assessment should integrate thyroid status with electrocardiography, echocardiography, and targeted use of advanced imaging and cardiac biomarkers. Management requires simultaneous correction of thyroid hormone excess and treatment of the associated cardiovascular phenotype, including appropriate rate control, anticoagulation, heart failure therapy, and management of ischemic manifestations. This narrative review summarizes the pathophysiological mechanisms, major clinical manifestations, diagnostic approach, reversibility, and contemporary management of cardiovascular involvement in hyperthyroidism.
Keywords: hyperthyroidism, cardiovascular disease, atrial fibrillation, thyrotoxic cardiomyopathy, heart failure
©2026 Özden, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.