From the Guidelines
Elevated blood pressure is often seen in African American female patients, and this risk may be compounded by the effects of total thyroidectomy on cardiovascular function. When considering the management of hypertension in African American female patients who have undergone total thyroidectomy, it's crucial to recognize the dual risk factors at play: the inherent higher risk of hypertension in African Americans compared to other ethnic groups, as highlighted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, and the potential for thyroidectomy to disrupt thyroid hormone balance, which can significantly affect cardiovascular function.
Key Considerations
- African Americans have a higher prevalence of hypertension than other ethnic groups, with lower control rates and higher morbidity and mortality attributed to hypertension, as noted in the guideline 1.
- Thyroidectomy requires thyroid hormone replacement therapy, typically with levothyroxine, to prevent hypothyroidism, which can cause increased peripheral vascular resistance and diastolic hypertension if inadequately managed.
- Hyperthyroidism from excessive thyroid hormone replacement can lead to systolic hypertension, emphasizing the need for careful dosing and monitoring.
- Regular blood pressure monitoring and thyroid function tests are essential for managing these patients, with adjustments in thyroid hormone replacement and antihypertensive therapy as needed.
Management Approach
- Proper thyroid hormone replacement is critical, with initial dosing typically at 1.6 mcg/kg/day of levothyroxine, and adjustments based on thyroid function tests every 6-8 weeks until stable, then annually.
- Standard hypertension treatments should be employed, including lifestyle modifications and medications. For African American patients, the guideline recommends initial antihypertensive treatment with a thiazide-type diuretic or a calcium channel blocker (CCB) in the absence of heart failure or chronic kidney disease, including those with diabetes 1.
- Consideration should be given to the fact that African American patients may respond differently to various antihypertensive medications, with a potential preference for certain classes like thiazide-type diuretics or CCBs over others, as suggested by the guideline 1.
From the Research
Elevated Blood Pressure in African American Female Patients
- Elevated blood pressure is a significant health issue in African American women, with a high prevalence of hypertension in this population 2, 3.
- Studies have shown that African American women are more likely to experience stage 2 hypertension (blood pressure ≥140/90 mm Hg) than other demographic groups 2.
- The causes of elevated blood pressure in African American women are multifactorial, including genetic, environmental, and socioeconomic factors 4, 5.
Total Thyroidectomy and Elevated Blood Pressure
- There is no direct evidence in the provided studies to suggest a link between total thyroidectomy and elevated blood pressure in African American female patients.
- However, it is known that thyroid disorders can affect blood pressure, and patients undergoing thyroidectomy may experience changes in blood pressure due to the surgery or underlying thyroid condition 4, 5.
Management of Elevated Blood Pressure
- The management of elevated blood pressure in African American women requires a comprehensive approach, including lifestyle modifications and antihypertensive medication 4, 5.
- Studies have shown that African American women may face unique challenges in managing their blood pressure, including misconceptions about hypertension and stigma associated with the condition 2, 3.
- Advanced practice nurses can play a crucial role in enhancing hypertension knowledge and self-management among African American women by addressing these misconceptions and providing culturally sensitive care 3.