Complications
Atrial fibrillation is the most common complication of thyrotoxicosis during the thyrotoxic phase of painless thyroiditis.[42] It is most seen in patients over 50 years of age and those with underlying cardiovascular disease and may be associated with embolic cerebrovascular accidents. Even subclinical thyrotoxicosis increases premature atrial contractions and the risk of supraventricular tachycardias. Treatment should aim to control heart rate and anticoagulation is frequently advised. Cardioversion, which often occurs spontaneously when euthyroidism is achieved, is best deferred until thyrotoxicosis has resolved.[31]
Patients may require urgent cardiac consultation and acute intervention for unstable angina.
Patients may require urgent cardiac consultation and acute intervention for CHF.
Patients who have had painless thyroiditis are more likely to develop permanent hypothyroidism in the future. For example, in one study half of the women with postnatal thyroiditis and persistent thyroid peroxidase (TPO) antibodies who had recovered thyroid function developed permanent hypothyroidism after 7 years.[40]
Rarely, patients with a history of painless thyroiditis go on to develop Graves' disease. If a patient develops recurrent hyperthyroidism, thyroid-stimulating hormone (TSH)-receptor antibodies should be measured, or 4-, 6-, or 24-hour radioiodine uptake should be repeated and other assessments of the aetiology of the thyrotoxicosis should be carried out.
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