From the Guidelines
The most related sign to thyrotoxicosis among the given options is B. Atrial fibrillation. Atrial fibrillation is a well-documented complication of thyrotoxicosis, and its management is crucial to prevent thromboembolic events and other cardiovascular complications 1. According to the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation, AF is the most common arrhythmia in patients with hyperthyroidism, and its treatment is directed primarily toward restoring a euthyroid state 1.
Some key points to consider in the management of atrial fibrillation in thyrotoxicosis include:
- The use of beta blockers to control the ventricular rate, unless contraindicated 1
- The use of nondihydropyridine calcium channel antagonists, such as diltiazem or verapamil, when beta blockers cannot be used 1
- The importance of anticoagulation to prevent thromboembolic events, guided by CHA2DS2-VASc risk factors 1
- The need to restore a euthyroid state to prevent recurrence of atrial fibrillation and other cardiovascular complications 1
In contrast, obesity, low energy level, and loss of hair at the lateral part of the eyebrows are not as directly related to thyrotoxicosis as atrial fibrillation. While these symptoms may be present in some patients with thyrotoxicosis, they are not as specific or diagnostic as atrial fibrillation. Therefore, atrial fibrillation is the most related sign to thyrotoxicosis among the given options.
From the Research
Thyrotoxicosis Signs
The most related sign to thyrotoxicosis among the given options is:
- B. Atrial fibrillation This is because atrial fibrillation is a well-documented complication of thyrotoxicosis, as seen in studies 2, 3, 4, 5.
Rationale
The association between thyrotoxicosis and atrial fibrillation is supported by the following points:
- Atrial fibrillation is the most common cardiac complication of hyperthyroidism, occurring in an estimated 10% to 25% of overtly hyperthyroid patients 3.
- The prevalence of atrial fibrillation increases with age in the general population and in thyrotoxic patients 3.
- Atrial fibrillation may be the only manifestation of thyrotoxicosis, and thyroid hormone excess should be routinely excluded in patients with this rhythm disturbance 2.
- The odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95% CI: 5.89-38.16, p = 0.001) 4.
- Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm, and anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score 5.
Other Options
In contrast, the other options are not as strongly associated with thyrotoxicosis:
- A. Obesity is not typically a sign of thyrotoxicosis, as weight loss is more commonly seen in hyperthyroidism.
- C. Low energy level is not a characteristic symptom of thyrotoxicosis, as hyperthyroidism often presents with increased energy and nervousness.
- D. Loss of hair at the lateral part of the eyebrows can be seen in hyperthyroidism, but it is not as specific or strongly associated with thyrotoxicosis as atrial fibrillation.