Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study
Main finding · AFResult — go to the resultHazard ratio 1.37 95% CI 1.22–1.55Authors' conclusion
SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.
Study context
- Population
- Patients in general practitioner (GP) data from the PHARMO Data Network, Netherlands (2012–2021)matched cohort
- Participants
- 11,163 vs 46,058
- Exposure
- Subclinical hyperthyroidism (SHT) vs matched euthyroid reference
- SHTn = 11,163
- Euthyroid referencen = 46,058reference
- Outcome
- Atrial fibrillation (AF)
Methodological detailsmatched on age, sex and GP practice, multivariable-adjusted Cox regression, No data on smoking and alcohol use; comorbidity history only for the one-year period prior to cohort entry
- Matched on age, sex and GP practice
- Multivariable-adjusted Cox regression
- No data on smoking and alcohol use; comorbidity history only for the one-year period prior to cohort entry
Main finding
As reported in the abstract
Hazard ratio
1.37
95% CI 1.22–1.55
SHTvs Euthyroid reference
HR 1.37 (95% CI 1.22–1.55)
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| AF, subgroup TSH < 0.1 mU/L | 1.60 (1.32–1.94) | |
| AF, subgroup aged 30-49 years | 1.88 (1.05–3.36) | |
| All-cause mortality, overall | 1.51 (1.38–1.64) | |
| All-cause mortality, subgroup men | 1.75 (1.50–2.05) | |
| All-cause mortality, subgroup aged 30-49 years | 2.95 (1.73–5.04) | |
| 0.20.5125Hazard ratio (log scale) |
Heart failure (HF), overall
- HF risk modestly elevated overall
- 1.21, 1.04-1.40 (HR, CI)
HF, subgroup aged 30-49 years
- Stronger HF effect in individuals aged 30-49 years
- 3.74, 1.52-9.24 (HR, CI)
HF, subgroup women
- Stronger HF effect in women
- 1.31, 1.10-1.56 (HR, CI)
Atherosclerotic complications
- Weak-to-modest association with atherosclerotic complications
- 1.12, 1.00-1.24 (HR, CI)
Original publication
Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study. Thyroid. Published 8 May 2026. doi:10.
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