LETTER
Hyperthyroidism
Kenneth A. Woeber
1 March 1995 | Volume 122 Issue 5 | Pages 393-394
TO THE EDITOR:
I enjoyed the article by Klein and associates [1] on the management of hyperthyroidism. However, I was surprised by their statement that anticoagulation with warfarin is not routinely recommended to prevent arterial thromboembolism in patients with hyperthyroidism and atrial fibrillation who do not have organic heart disease (mitral valve disease) or congestive heart failure. This statement is not consistent with data that the reported frequency of arterial thromboembolism exceeds that of congestive heart failure or mitral valve disease in patients with hyperthyroidism [2-4]. Given the devastating effect of arterial thromboembolism and the documented protective effects of anticoagulation, it seems prudent to routinely recommend warfarin treatment unless contraindications to its use exist.
1. Klein I, Becker DV, Levey GS. Treatment of hyperthyroid disease. Ann Intern Med. 1994; 121:281-8.
2. Presti CF, Hart RG. Thyrotoxicosis, atrial fibrillation, and embolism, revisited. Am Heart J. 1989; 117:976-7.
3. Summers VK, Surtees SJ. Thyrotoxicosis and heart disease. Acta Med Scand. 1961; 169:661-71.
4. Woeber KA. Thyrotoxicosis and the heart. N Engl J Med. 1992; 327:94-8.
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