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Hyperthyroidism and Atrial Fibrillation

Published April 27 2015

People with hyperthyroidism and Graves’ Disease are at an increased risk of developing atrial fibrillation.  This is the most common type of arrhythmia, which involves an abnormal heart rate and/or heart rhythm.  Some people with atrial fibrillation won’t experience any symptoms, while others will experience symptoms such as an increased awareness of the rapid and irregular pulse, dizziness, light-headedness, fatigue, and shortness of breath.  While I’m sure this sounds scary to those people with hyperthyroid conditions, the most common reason why atrial fibrillation occurs is because precautions aren’t taken to lower the increased heart rate through either the use of antithyroid medication or herbs.

The heart has four chambers and four valves, and is connected to numerous blood vessels, including arteries and veins.  The atria are the two upper chambers of the heart, and these two chambers collect blood as it flows into the heart.  The lower two chambers of the heart are called the ventricles, and they pump blood out of the heart into the lungs and other parts of the body.  Atrial fibrillation occurs when the upper chambers of the heart are out of sync with the two lower chambers.  In addition to hyperthyroidism, other causes of atrial fibrillation include alcohol, cigarette smoking, and certain medications (i.e. drugs for blood pressure or depression).  Some sources state that caffeine can increase the risk of atrial fibrillation, although the research I have done showed this not to be the case (1) [1] (2) [2].

What Are The Risks Of Atrial Fibrillation?

Atrial fibrillation can increase the risk of blood clot formation inside the heart, and these blood clots can cause an embolism, stroke, or other conditions (3) [3].  It is the most common cardiac complication of hyperthyroidism (3) [3], and even those people with subclinical hyperthyroidism have an increased risk of developing atrial fibrillation (4) [4] (5) [5].  So hopefully you understand that atrial fibrillation can be a serious condition, and while it usually doesn’t result in blood clots and other life threatening problems, it still isn’t something to take lightly.

How Can Atrial Fibrillation Be Diagnosed?

How does a doctor determine if a patient has atrial fibrillation?  Initially the doctor will most likely use a stethoscope to listen to the patient’s heart, and will also measure their pulse rate.  A Holter monitor might also be used, as this is a device that continuously records the heart’s rhythms, and is typically worn for 24 to 48 hours.  An electrocardiogram and/or echocardiogram might be used, or in some cases coronary angiography might be used to determine if someone has atrial fibrillation (6) [6] (7) [7].

Treatment Options For Atrial Fibrillation

As for the treatment options, this depends on the severity.  In some severe cases electrical shock therapy might be necessary, or a short-term heart pacemaker.  Anti-arrhythmic drugs may be used control the arrhythmia and/or control the heart rate.  Fortunately these treatment methods aren’t necessary in most people with an arrhythmia.  Anticoagulants (blood thinners) might also be recommended such as warfarin, rivaroxaban, or apixaban.  Patients taking warfarin might be at an increased risk of stroke during the first 30 days of treatment (8) [8], and other medications such as apixaban might cause fewer major bleeding events (9) [9].

You might wonder if natural treatment methods can help with atrial fibrillation.  There are certain anti-arrhythmic herbs such as motherwort, hawthorn, and even ginkgo.  Although these can benefit some people who currently have atrial fibrillation, they seem to work better in helping to prevent it from developing.  If someone is already taking a beta blocker they need to be careful about taking these herbs, especially motherwort and hawthorn.  While I have had some patients on beta blockers take motherwort or hawthorn, both the medication and herbs can lower heart rate and blood pressure, and so if one is taking a beta blocker and then takes high doses of these herbs it can drop the blood pressure too low in some cases.  In addition, if someone is taking warfarin then these herbs can affect the anticoagulation action (10) [10] (11) [11].

While taking herbs might be beneficial for those with atrial fibrillation, stress management also is something to consider.  There have been a few smaller studies showing that yoga can benefit those with atrial fibrillation (12) [12] (13) [13], and I came across one study which showed that Qi gong can also be beneficial (14) [14].  I frequently talk about the importance of stress management, and this is yet another example of why improving one’s stress handling skills is important in order to achieve optimal health.  I’m not suggesting that managing one’s stress alone can prevent or cure atrial fibrillation, but doing things to improve stress can help.

In summary, atrial fibrillation is common in hyperthyroid conditions.  Although some people with atrial fibrillation will experience symptoms such as light-headedness, fatigue, and shortness of breath, other people won’t experience any symptoms.  This condition can increase the risk of blood clot formation, and as a result shouldn’t be taken lightly.  Unmanaged hyperthyroidism is the main reason why people with this condition develop atrial fibrillation.  Conventional treatment options can include anti-arrhythmic drugs, anti-coagulants, and in more severe cases a pacemaker or electrical shock therapy might be necessary.  Anti-arrhythmic herbs such as motherwort, hawthorn, and ginkgo may also be beneficial.  And some smaller studies show benefits with mind body medicine techniques such as yoga and Qi gong.