HEART RHYTHM DISORDERS IN PATIENTS WITH DIFFUSE TOXIC GOITER UNDER CONDITIONS OF STRESS ASSOCIATED WITH MARTIAL LAW

Abstract

Background. In modern medicine, the fact of the influence of stressful situations on the functioning of the thyroid gland is generally recognized, as well as the influence of thyroid hormones on the functioning of the cardiovascular system. In the situation of martial law, which has been going on in Ukraine for more than two years, stress acquires the characteristics of chronic and, what is also important, does not decrease in its perception over time by most people, including patients diffuse toxic goiter (DTG), negatively affecting the state of their cardiovascular system.

The aim. To determine the features of heart rhythm disorders in patients with diffuse toxic goiter diagnosed during the period of martial law in Ukraine.

Materials and methods. Sex-age characteristics and duration of accidents, as well as the prevalence and nature of heart rhythm disorders in 110 patients who were treated in the clinic of the SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine" in the period 2022-2023 were analyzed. Patients were divided into two groups depending on the period of disease manifestation (before the period of martial law – the comparison group, and during the period of martial law – the main group) and two gender subgroups. The main group consisted of 31 women (72.01%) aged 49.48±2.32 years and 12 men (27.99%) aged 48.66±3.57 years. The comparison group consisted of 56 women (83.58%) aged 48.66±1.44 years and 11 men (16.42%) aged 46.73±2.35 years.

Results. The analysis of gender subgroups revealed a predominance of women with DTG in both groups. When comparing the ratio of men and women between groups by the time of manifestation DTG, an almost 2-fold increase in the percentage of sick men with manifestation during the years of martial law was revealed. There was no significant difference between the age indicators and the distribution of patients according to the severity of the disease in both groups. The obtained data indicate that in men with DTG, heart rhythm disturbances as atrial fibrillation is formed with a probably shorter disease duration on DTG than sinus tachycardia (Р<0.05; 2.0±0.58 vs. 4.5±1.14). Against the background of cases that occurred during the years of martial law, AF is diagnosed earlier than for cases that were manifested before 2022. This applies to both men and, to a greater extent, women. At the same time, in the cases until 2022, atrial fibrillation was determined later in women than in men (7.63±1.45 vs. 3.0±0). Thus, the obtained results demonstrate that all examined patients with DTG had rhythm disturbance in the form of sinus tachycardia or atrial fibrillation. The stressful situation associated with the war in Ukraine rejuvenates the development of atrial fibrillation, especially in men. Under such circumstances, it is necessary to examine people with heart rhythm disorders for the presence of DTG and monitor the heart rhythm in patients with diffuse goiter, because antithyroid therapy can positively affect heart rhythm disorders.

Conclusions. In the conditions of martial law, stress acquires chronic characteristics and accelerates the development of atrial fibrillation in patients with diffuse toxic goiter, probably more often in women. Among patients with diffuse toxic goiter, rhythm disturbances in the form of atrial fibrillation both before the war and during martial law are registered mainly in female patients. In the group of patients with the manifestation of diffuse toxic goiter during wartime, the specific gravity of men with rhythm disorders (atrial fibrillation and sinus tachycardia) increases by almost 2 times. Heart rhythm disturbances in the form of atrial fibrillation in men occur with a probably shorter duration of diffuse toxic goiter than sinus tachycardia.