Graves Disease with Heart Rhythm Disorders


  • M Agung Yudistira Permana
  • Widyanto P Adhy
  • Nurmalinda Kurniasih Mappapa
  • Iriyanti Aderina Patola



Atrial fibrillation, graves disease, hyperthyroidism


Hyperthyroidism is an endocrine disorder with the second highest incidence after diabetes, the most common hyperthyroidism (60% -80% of cases) is caused by Graves’ disease. Graves' disease is an autoimmune disorder, the presence of thyroid stimulating immunoglobulin (TSI), or can be called a thyroid stimulating antibody (TSAb) which is secreted in the thyroid gland binding to thyroid stimulating hormone (TSH) receptors in the thyroid gland to stimulate the thyroid gland  to produce hormones . In this case, Ms. FF 47th came with thumping chest since one week before came to hospital, accompanied by excessive sweating and trembling hands. There is enlargement of the skin-colored, painless thyroid gland with no firm boundary. From TSH laboratory results <0.1 µU/mL, total T4 and T3 are 157 µg/dL and 8.9ng/dL accompanied by atrial fibrillation on the ECG. Given 3x100mg PTU therapy and oral 3x30mg propanolol obtained good results on the third day of treatment. A long evaluation and monitoring is needed to ensure that the patient has healing.


Barrett K, Barman S, Boitano S, Brooks H. Ganong’s Review of Medical Physiology, 25e. New York, NY McGraw-Hill. 2016;

Bott R. Guyton and Hall Textbook of Medical Physiology 13ed. Igarss 2014. 2014.

Ariani D. Ny . Z Usia 47 Tahun dengan Penyakit Graves. J Medula Unila. 2016;4(3):30–4.

Hussain YS, Hookham JC, Allahabadia A, Balasubramanian SP. Epidemiology, management and outcomes of Graves’ disease—real life data. Endocrine [Internet]. 2017;56(3):568–78. Available from:

Leo S De, Lee SY, Braverman LE, Unit E, Sciences C. Hyperthyroidism_Lancet review. HHS Public Access. 2016;388(10047):906–18.

Diana T, Olivo PD, Kahaly GJ. Thyrotropin Receptor Blocking Antibodies Authors Key words. 2018;

Wémeau J louis, Klein M, Sadoul JL, Briet C, Vélayoudom-Céphise FL. Graves’ disease: Introduction, epidemiology, endogenous and environmental pathogenic factors. Ann Endocrinol (Paris). 2018;

Rago T, Cantisani V, Ianni F, Chiovato L, Garberoglio R, Durante C, et al. Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM). J Endocrinol Invest. 2018;

Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European thyroid association guideline for the management of graves’ hyperthyroidism. European Thyroid Journal. 2018.

Kotwal A, Stan M. Thyrotropin Receptor Antibodies-An Overview. Ophthalmic plastic and reconstructive surgery. 2018.

Subekti I, Pramono LA. Current Diagnosis and Management of Graves’ Disease. Acta medica Indonesiana. 2018.

Minamitani K, Sato H, Ohye H, Harada S, Arisaka O. Guidelines for the treatment of childhood-onset graves’ disease in Japan, 2016. Clin Pediatr Endocrinol. 2017;

Aung ET, Zammitt NN, Dover AR, Strachan MWJ, Seckl JR, Gibb FW. Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis. Clin Endocrinol (Oxf). 2019;

Mallick R, Asban A, Chung S, Hur J, Lindeman B, Chen H. To admit or not to admit? Experience with outpatient thyroidectomy for Graves’ disease in a high-volume tertiary care center. Am J Surg. 2018;

Garstka M, Kandil E, Saparova L, Bechara M, Green R, Haddad AB, et al. Surgery for Graves’ disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population. Langenbeck’s Arch Surg. 2018;

Lin SH, Huang CL. Mechanism of thyrotoxic periodic paralysis. Journal of the American Society of Nephrology. 2012.

Heijman J, Voigt N, Wehrens XHT, Dobrev D. Calcium dysregulation in atrial fibrillation: The role of CaMKII. Frontiers in Pharmacology. 2014.

Osman F, Gammage MD, Sheppard MC, Franklyn JA. Cardiac dysrhythmias and thyroid dysfunction: The hidden menace? Journal of Clinical Endocrinology and Metabolism. 2002.

Longo D, Fauci A, Kasper D, Hauser S, Jameson L, Loscalzo J. Harrison: principios de medicina interna (18° ed). In: Harrison Principios de Medicina interna. 2012.

Katzung BG. Basic & Clinical Pharmacology. Basic and clinical Pharmacology. 2012.



How to Cite

M Agung Yudistira Permana, Widyanto P Adhy, Nurmalinda Kurniasih Mappapa, & Iriyanti Aderina Patola. (2020). Graves Disease with Heart Rhythm Disorders. Medical Profession Journal of Lampung, 10(2), 292-296.




Most read articles by the same author(s)