{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:36:44Z","timestamp":1777423004568,"version":"3.51.4"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:00:00Z","timestamp":1624838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:00:00Z","timestamp":1624838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89\u2009% of the cases. The most frequent etiology was multinodular toxic goiter (51.5\u2009%). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6\u2009% of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3\u2009%) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR\u2009=\u200915.95, 95\u2009% CI:5.89\u201338.16,<jats:italic>p<\/jats:italic>\u2009=\u20090.001) and tachycardia (AOR\u2009=\u20092.73, 95\u2009% CI:1.04\u20137.15,<jats:italic>p<\/jats:italic>\u2009=\u20090.040). All patients took propylthiouracil and 13.0\u2009% of them experienced its side effects. Concerning \u03b2-blockers, propranolol was the most commonly (78.5\u2009% of the cases) used drug followed by atenolol (15.0\u2009%). Six patients underwent surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12902-021-00796-5","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T12:02:47Z","timestamp":1624881767000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Thyrotoxicosis and dilated cardiomyopathy in developing countries"],"prefix":"10.1186","volume":"21","author":[{"given":"Bisrat Tesfay","family":"Abera","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merhawit Atsbha","family":"Abera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gebretsadik","family":"Berhe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girmatsion Fisseha","family":"Abreha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirut Teame","family":"Gebru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiluf Ebuy","family":"Abraha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamedawel Mohamedniguss","family":"Ebrahim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,28]]},"reference":[{"issue":"4","key":"796_CR1","first-page":"287","volume":"50","author":"D Kebede","year":"2012","unstructured":"Kebede D, Abay Z, Feleke Y. Pattern, clinical presentations and management of thyroid diseases in national endocrine referral clinics, Tikur Anbessa Specialized Hospital, Addis Ababa\u00a0Ethiopia. Ethiop Med J. 2012;50(4):287\u201395.","journal-title":"Ethiop Med J"},{"key":"796_CR2","unstructured":"Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison\u2019s principles of internal medicine 19th Ed. McGraw-Hill Medical; 2014.:2283\u20132308."},{"issue":"1","key":"796_CR3","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1093\/bmb\/ldr030","volume":"99","author":"MPJ Vanderpump","year":"2011","unstructured":"Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39\u201351.","journal-title":"Br Med Bull"},{"key":"796_CR4","unstructured":"Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's principles of internal medicine, 19e. Mcgraw-hill; 2015. p. 2283\u2013308."},{"issue":"3","key":"796_CR5","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1111\/cen.12816","volume":"84","author":"B Goichot","year":"2016","unstructured":"Goichot B, Caron P, Landron F, Bou\u00e9e S. Clinical presentation of hyperthyroidism in a large representative sample of outpatients in France: Relationships with age, aetiology and hormonal parameters. Clin Endocrinol (Oxf). 2016;84(3):445\u201351.","journal-title":"Clin Endocrinol (Oxf)"},{"key":"796_CR6","unstructured":"Ogbera A, Isiba A. The scope of cardiac complications of thyrotoxicosis in Lagos, Nigeria. InSociety for Endocrinology BES 2007;13. BioScientifica."},{"issue":"15","key":"796_CR7","first-page":"1675","volume":"164","author":"L Frost","year":"2004","unstructured":"Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Itern Med. 2004;164(15):1675\u20138.","journal-title":"Arch Itern Med"},{"key":"796_CR8","doi-asserted-by":"crossref","unstructured":"Kandan V, Sathyamurthy P, Rajkumar M, Narayanan L. Cardiovascular manifestations in hyperthyroidism. Int J Res Med Sci.\u00a02016;4(7):3032\u20138.","DOI":"10.18203\/2320-6012.ijrms20161999"},{"key":"796_CR9","doi-asserted-by":"crossref","unstructured":"Goland S, Shimoni S, Kracoff O. Dilated cardiomyopathy in thyrotoxicosis. Heart 1999;81(4):444-5.","DOI":"10.1136\/hrt.81.4.444"},{"issue":"3","key":"796_CR10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1177\/2042018810382481","volume":"1","author":"R Carroll","year":"2010","unstructured":"Carroll R, Matfin G. Review: Endocrine and metabolic emergencies: Thyroid storm. Ther Adv Endocrinol Metab. 2010;1(3):139\u201345.","journal-title":"Ther Adv Endocrinol Metab"},{"issue":"3","key":"796_CR11","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1177\/0885066613498053","volume":"30","author":"M Chiha","year":"2015","unstructured":"Chiha M, Samarasinghe S, Kabaker AS. Thyroid Storm: An Updated Review. J Intensive Care Med. 2015;30(3):131\u201340.","journal-title":"J Intensive Care Med"},{"key":"796_CR12","unstructured":"Pearce EN. Diagnosis and management of thyrotoxicosis Clinical review Diagnosis and management of thyrotoxicosis. BMJ.\u00a02006;5128:1\u201311."},{"issue":"12","key":"796_CR13","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1089\/thy.2014.0028","volume":"24","author":"J Jonklaas","year":"2014","unstructured":"Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670\u2013751.","journal-title":"Thyroid"},{"issue":"971","key":"796_CR14","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1136\/pgmj.2006.047290","volume":"82","author":"LD Premawardhana","year":"2006","unstructured":"Premawardhana LD, Lazarus JH. Management of thyroid disorders. Postgraduate Med J. 2006;82(971):552\u20138.","journal-title":"Postgraduate Med J"},{"issue":"3","key":"796_CR15","first-page":"152","volume":"17","author":"B Reine","year":"2017","unstructured":"Reine B La, Affairs M, Serono M, Diseases M. Survey of Clinical Practice Patterns in the Management of 992 Hyperthyroid Patients in France. Endocr Pract. 2017;17(3):152\u20139.","journal-title":"Endocr Pract"},{"key":"796_CR16","first-page":"2157","volume":"92","author":"S Allan","year":"2007","unstructured":"Allan S. Brett M. Methimazole vs. Propylthiouracil for Hyperthyroidism. NEJM Endocr Watch. 2007;92:2157\u201362.","journal-title":"NEJM Endocr Watch"},{"key":"796_CR17","doi-asserted-by":"crossref","unstructured":"Ogbera AO, Kuku SF. Epidemiology of thyroid diseases in Africa. Indian journal of endocrinology and metabolism. 2011 Jul;15(Suppl2):S82.","DOI":"10.4103\/2230-8210.83331"},{"key":"796_CR18","unstructured":"Ayder Comprehensive Specialized Hospital-Mekelle University Profile: 2020. Available from: http:\/\/www.mu.edu.et\/chs\/index.php\/ayder-referral-hospital."},{"issue":"1","key":"796_CR19","first-page":"1","volume":"2","author":"RK Gyasi","year":"2013","unstructured":"Gyasi RK. Thyroid Disorders in Accra, Ghana : A Retrospective Histopathological Study at the Korle-Bu Teaching Hospital. J Med Biomed Sci. 2013;2(1):1\u20137.","journal-title":"J Med Biomed Sci"},{"key":"796_CR20","doi-asserted-by":"crossref","unstructured":"Gebreyohannes EA, Ayele EM, Tesfaye SA, Seid MA. Normalization of thyroid function tests among thyrotoxicosis patients attending a University Hospital in North-West Ethiopia. Thyroid research. 2019;12(1):1-8.","DOI":"10.1186\/s13044-019-0064-2"},{"key":"796_CR21","doi-asserted-by":"publisher","first-page":"216495612092362","DOI":"10.1177\/2164956120923624","volume":"9","author":"G Gebremichael","year":"2020","unstructured":"Gebremichael G, Demena M, Egata G, Gebremichael B. Prevalence of Goiter and Associated Factors Among Adolescents in Gazgibla District\u00a0Northeast Ethiopia. Global Adv Health Med. 2020;9:2164956120923624.","journal-title":"Global Adv Health Med"},{"key":"796_CR22","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s40795-020-00345-8","volume":"6","author":"A Asfaw","year":"2020","unstructured":"Asfaw A, Belachew T. Magnitude of iodine deficiency disorder and associated factors in Dawro zone, Southwest Ethiopia; the hidden hunger: a cross-sectional study. BMC Nutr. 2020;6:20. https:\/\/doi.org\/10.1186\/s40795-020-00345-8.","journal-title":"BMC Nutr"},{"key":"796_CR23","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40795-016-0051-0","volume":"2","author":"TM Gebretsadikan","year":"2016","unstructured":"Gebretsadikan TM, Troen AM. Progress and challenges in eliminating iodine deficiency in Ethiopia: a systematic review. BMC Nutr. 2016;2:12. https:\/\/doi.org\/10.1186\/s40795-016-0051-0.","journal-title":"BMC Nutr"},{"key":"796_CR24","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s13690-016-0158-4","volume":"74","author":"S Hailu","year":"2016","unstructured":"Hailu S, Wubshet M, Woldie H, et al. Iodine deficiency and associated factors among school children: a cross-sectional study in Ethiopia. Arch Public Health. 2016;74:46. https:\/\/doi.org\/10.1186\/s13690-016-0158-4.","journal-title":"Arch Public Health"},{"issue":"2","key":"796_CR25","first-page":"327","volume":"17","author":"AO1 Ogbera","year":"2007","unstructured":"Ogbera AO1, Fasanmade O AO. Pattern of thyroid disorders in the SouthWestern region of Nigeria. NCBI. 2007;17(2):327\u201330.","journal-title":"NCBI"},{"issue":"09","key":"796_CR26","first-page":"8484","volume":"6","author":"SV Dhadke","year":"2014","unstructured":"Dhadke SV, Dhadke VN, Korade MB, Sangle SA. Research Article Clinical Profile of Thyroid Disorders. Int J Curr Res. 2014;6(09):8484\u20138.","journal-title":"Int J Curr Res"},{"key":"796_CR27","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1210\/jcem.87.3.8217","volume":"87","author":"O Faizel","year":"2002","unstructured":"Faizel O, Michael DG, Michael CS, et al. Cardiac dysrhythmias and thyroid dysfunctionThe hidden menace? J Clin Endocrinol Metab 2002;87:963\u20137.","journal-title":"J Clin Endocrinol Metab"},{"key":"796_CR28","doi-asserted-by":"publisher","unstructured":"Finomo OF, Jesuorobo DE, Thyrotoxic Cardiomyopathy: A Case Report, International Journal of Internal Medicine. 2017;6(3):49-51. https:\/\/doi.org\/10.5923\/j.ijim.20170603.02.","DOI":"10.5923\/j.ijim.20170603.02"},{"issue":"3","key":"796_CR29","doi-asserted-by":"publisher","first-page":"46","DOI":"10.31031\/GGS.2017.01.000512","volume":"1","author":"A Ademolu","year":"2017","unstructured":"Ademolu A. Thyrotoxic Cardiomyopathy: A Study of Three Cases. Gerontol Geriatr Stud. 2017;1(3):46\u20139.","journal-title":"Gerontol Geriatr Stud"},{"issue":"7","key":"796_CR30","first-page":"3032","volume":"4","author":"V Kandan","year":"2016","unstructured":"Kandan V, Sathyamurthy P, Rajkumar M, Narayanan L. Cardiovascular manifestations in hyperthyroidism. 2016;4(7):3032\u20138.","journal-title":"Cardiovascular manifestations in hyperthyroidism"},{"key":"796_CR31","first-page":"173","volume":"34","author":"H Surchi","year":"2014","unstructured":"Surchi H, Usha Ayyagari. Thyrotoxic cardiomyopathy. Endocr Abstr. 2014;34:173\u20134.","journal-title":"Endocr Abstr"},{"key":"796_CR32","doi-asserted-by":"crossref","unstructured":"American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646.","DOI":"10.1089\/thy.2010.0417"},{"key":"796_CR33","doi-asserted-by":"crossref","unstructured":"Emiliano AB, Governale L, Parks M, Cooper DS. Shifts in Propylthiouracil and Methimazole Prescribing Practices: antithyroid Drug Use in the United States from 1991 to 2008. 2014;95:2227\u201333.","DOI":"10.1210\/jc.2009-2752"},{"key":"796_CR34","doi-asserted-by":"crossref","unstructured":"Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction duringpregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. The journal of clinical Endocrinology & Metabolism. 2007;92(8_supplement):s1-7.","DOI":"10.1210\/jc.2007-0141"},{"key":"796_CR35","doi-asserted-by":"crossref","unstructured":"Cooper DS, Rivkees SA. Putting Propylthiouracil in Perspective. The Journal of Clinical Endocrinology & Metabolism.\u00a02009;94:1881\u20132.","DOI":"10.1210\/jc.2009-0850"},{"key":"796_CR36","doi-asserted-by":"crossref","unstructured":"Cooper DS. Antithyroid drugs. New England Journal of Medicine. 2005;352(9):905-17.","DOI":"10.1056\/NEJMra042972"},{"key":"796_CR37","doi-asserted-by":"crossref","unstructured":"Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber for the American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200-35.","DOI":"10.1089\/thy.2012.0205"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-021-00796-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-021-00796-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-021-00796-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T19:17:45Z","timestamp":1672600665000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-021-00796-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,28]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["796"],"URL":"https:\/\/doi.org\/10.1186\/s12902-021-00796-5","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,28]]},"assertion":[{"value":"24 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical clearance was obtained from the Ethical Review Committee of Mekelle University, College of health sciences with ethical clearance number ERC: 1408\/2018. The purpose of the study was explained to participants. Informed consent was obtained from participants. Participant involvement in the study was also voluntary. Confidentiality of information was assured. All methods are done per relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Comepting interests"}}],"article-number":"132"}}