Correlation of Serum FT4 with Serum Uric Acid and Comparison of Uric Acid in Subjects with and without Atrial Fibrillation in Graves’ Disease: A Cross-Sectional Study

Authors

  • Bella Yunita Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Imam Subekti Division of Endocrine, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Birry Karim Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Murdani Abdullah Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Cleopas Martin Rumende Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Dyah Purnamasari Division of Endocrine, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Juferdy Kurniawan Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Adityo Susilo Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

Atrial fibrillation, Free T4, Graves’ disease, Uric acid

Abstract

Background: Cardiovascular diseases increase the mortality risk in Graves’ disease (GD) patients. Atrial fibrillation (AF) is one of the most prevalent cardiovascular diseases in GD. Hyperthyroidism that occurs in GD may increase uric acid levels, while uric acid levels can also increase the risk of AF in the general population. This study is designed to observe the correlation between free T4 (FT4) and uric acid, and compare the levels of uric acid in subjects with and without AF in GD. Methods: A cross-sectional study was conducted, including GD patients who met research criteria in Dr. Cipto Mangunkusumo Hospital during 2024. We performed history taking, physical examination, laboratory examination, and electrocardiogram for each subject. Data was analyzed using Pearson or Spearman correlation, and bivariate analysis to evaluate the comparison of uric acid in subjects with and without AF. Results: We included 74 subjects, with an average age of 41 years, mostly female (86.5%), and 62.2% had normal FT4 levels. AF occurred only in 4.1% subjects. Mean of uric acid is 4.71 ± 1.2 mg/dl, which is within the normal range. No correlation was found between FT4 and uric acid (r = 0.076; p = 0.520), including after adjustment with subgroup analysis based on thyroid status, gender, and diabetes mellitus. Mean of uric acid is not statistically different between subjects with and without AF (4.9 ± 1.01 mg/dl vs 4.7 ± 1.2 mg/dl; p = 0.785). Conclusion: No significant correlation was found between FT4 and uric acid. Mean of uric acid is not statistically different between subjects with and without AF.

References

Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European thyroid association guideline for the management of Graves’ hyperthyroidism. Vol. 7, European Thyroid Journal. S. Karger AG; 2018. p. 167–86.

Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. Riset kesehatan dasar (Riskesdas). 2013.

Subekti I, Pramono LA. Current diagnosis and management of Graves’ disease. Acta Med Indones-Indones J Intern Med. 2018;50(2):177–82.

Cappola AR, Desai AS, Medici M, et al. Thyroid and cardiovascular disease: research agenda for enhancing knowledge, prevention, and treatment. Circulation. 2019 Jun 18;139(25):2892–909.

Kelompok Studi Tiroidologi Indonesia. Pedoman pengelolaan penyakit hipertiroid. 2017. 1–41 p.

Brandt F, Thvilum M, Almind D, et al. Graves’ disease and toxic nodular goiter are both associated with increased mortality but differ concerning the cause of death: a Danish population-based register study. Thyroid. 2013 Apr 1;23(4):408–13.

Kostopoulos G, Effraimidis G. Epidemiology, prognosis, and challenges in the management of hyperthyroidism-related atrial fibrillation. Eur Thyroid J. 2024;13:e230254.

Naser JA, Pislaru S V., Stan MN, Lin G. Incidence, risk factors, and outcomes of incident atrial fibrillation in patients with Graves disease. Mayo Clin Proc. 2023;98(6):883–91.

Kalra S, Aggarwal S, Khandelwal D. Thyroid dysfunction and dysmetabolic syndrome: the need for enhanced thyrovigilance strategies. Int J Endocrinol. 2021;2021:9641846.

Zhou J, Yu X, Lou Y, Bao J, Xia Y, Zhu L. Detection and correlation analysis of serum uric acid in patients with thyroid-associated ophthalmopathy. Comput Math Methods Med. 2022;2022:8406834.

Du R, Wang F, Yang C, et al. Metabolic features of orbital adipose tissue in patients with thyroid eye disease. Front Endocrinol (Lausanne). 2023;14:1151757.

Sato A, Shirota T, Shinoda T, et al. Hyperuricemia in patients with hyperthyroidism due to Graves’ disease. Metabolism. 1995;44(2):207–11.

Giordano N, Santacroce C, Mattii G, Geraci S, Amendola A, Gennari C. Hyperuricemia and gout in thyroid endocrine disorders. Clin Exp Rheumatol. 2001;19:661–5.

Ye Y, Gai X, Xie H, Li J, Zhang S. Association between serum free thyroxine (FT4) and uric acid levels in populations without overt thyroid dysfunction. Ann Clin Lab Sci [Internet]. 2015;45:49–53. Available from: www.annclinlabsci.org

Chao G, Zhu Y, Fang L. Retrospective analysis of the correlation between uric acid and thyroid hormone in people with normal thyroid function. J Diabetes Res. 2019;2019:5904264.

See LC, Kuo CF, Yu KH, et al. Hyperthyroid and hypothyroid status were strongly associated with gout and weakly associated with hyperuricaemia. PLoS One. 2014 Dec 8;9(12):e114579.

Patel S, Singh M, Garima G, Kahlon N. Correlation of serum uric acid with thyroid hormones in patients in a tertiary care hospital in Northern India. Medica Innovatica. 2023;12(1):92–9.

Helmy MY. Correlation between uric acid and thyroid hormones in patients with thyroid disorders. A case-control study. Egypt J Hosp Med [Internet]. 2020;81(2):1499–505. Available from: https://ejhm.journals.ekb.eg/

Vishwanath H, Kavitha S. Uric acid levels and thyroid status. Int J Curr Adv Res [Internet]. 2019 Nov 28;8(11):20508–12. Available from: http://dx.doi.org/10.24327/ijcar.2019

Noureen F, Ayub S, Khan AS. Correlation of serum uric acid, thyroid-stimulating hormone, and thyroxine in subclinical and overt hypothyroidism. Journal of Islamic International Medical College. 2020 Jun;15(2):94–7.

Akagunduz B, Akcakaya M. Evaluation of the correlation of urea, creatine, and uric acid levels with TSH in patients with newly diagnosed overt and subclinical hypothyroidism. Eurasian Journal of Medical Investigation. 2021;5(3):317.

Eranhikkal H, Asha E, Krishnan NR, et al. Evaluation of serum creatinine and serum uric acid in hypothyroid patients: a cross-sectional study. Journal of Clinical and Diagnostic Research. 2023;17(10):BC06-BC10.

Torkian P, Mansournia M, Mansournia N. Evaluation of biochemical markers of kidney function in patients with subclinical hypothyroidism in comparison with euthyroid people. J Family Med Prim Care. 2020;9(8):4234–9.

Pak S, Yatsynovich Y, Valencia D, Chen T. Serum uric acid and atrial fibrillation: meta-analysis. Crit Pathw Cardiol. 2018 Sep 1;17(3):161–6.

Zhang J, Zheng R, Li H, Guo J. Serum uric acid and incident atrial fibrillation: a systematic review and dose–response meta-analysis. Clin Exp Pharmacol Physiol. 2020 Nov 1;47(11):1774–82.

Wang X, Hou Y, Wang X, et al. Relationship between serum uric acid levels and different types of atrial fibrillation: an updated meta-analysis. Nutrition, Metabolism and Cardiovascular Diseases. 2021 Sep 22;31(10):2756–65.

Gao Z, Shi H, Xu W, et al. Hyperuricemia increases the risk of atrial fibrillation: a systematic review and meta-analysis. Int J Endocrinol. 2022;2022:8172639.

Deng Y, Liu F, Yang X, Xia Y. The key role of uric acid in oxidative stress, inflammation, fibrosis, apoptosis, and immunity in the pathogenesis of atrial fibrillation. Front Cardiovasc Med. 2021 Feb 26;8:641136.

Zhang J, Meng Z, Zhang Q, et al. Gender impact on the correlations between subclinical thyroid dysfunction and hyperuricemia in Chinese. Clin Rheumatol. 2016 Jan 1;35(1):143–9.

Li R, Wu B, Han M, et al. Uric acid metabolic disorders in the pituitary-target gland axis. Diabetes, Metabolic Syndrome, and Obesity. 2024;17:661–73.

Naguib R, Elkemary E. Thyroid dysfunction and renal function: a crucial relationship to recognize. Cureus. 2023 Feb 21;15(2):e35242.

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Published

2025-10-03

How to Cite

Yunita, B., Subekti, I., Karim, B., Abdullah, M., Rumende, C. M., Purnamasari, D. ., Kurniawan, J., & Susilo, A. (2025). Correlation of Serum FT4 with Serum Uric Acid and Comparison of Uric Acid in Subjects with and without Atrial Fibrillation in Graves’ Disease: A Cross-Sectional Study. Acta Medica Indonesiana, 57(3), 346. Retrieved from http://actamedindones.org/index.php/ijim/article/view/2919

Issue

Vol. 57 No. 3 (2025): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

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Copyright (c) 2025 Bella Yunita, Imam Subekti, Birry Karim, Murdani Abdullah, Cleopas Martin Rumende, Rr Dyah Purnamasari Sulistianingsih, Juferdy Kurniawan, Adityo Susilo

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