Control of breathing in patients with severe hypothyroidism

Duranti, Roberto; Gheri, R. G.; Gorini, Massimo; Gigliotti, Francesco; Spinelli, Andrea; Fanelli, Alessandra; Scano, Giorgio

doi:10.1016/0002-9343(93)90229-i

Cited by 41 publications

(29 citation statements)

References 26 publications

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“…In previous papers, we have thoroughly criticized the use of either surface or oesophageal EMG recording to assess respiratory drive in humans [9,15,19,[33][34][35][36]. Nonetheless, many data in normal and in disease state support the contention that the slope of the moving time average (Edi/TI) is a reliable measure of the respiratory centre activity [9,[11][12][13][14][15][16][17][18][19][20][21][33][34][35][36]. In the present study, chemoresponsiveness, expressed in terms of Edi response slope (∆XP/TI/∆PCO 2 ), increased from C to A (p<0.028 KWAV).…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia

Scano¹,

Spinelli²,

Duranti³

et al. 1995

Eur Respir J

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C Ca ar rb bo on n d di io ox xi id de e r re es sp po on ns si iv ve en ne es ss s i in n C CO OP PD D p pa at ti ie en nt ts s w wi it th h a an nd d w wi it th ho ou ut t c ch hr ro on ni ic c h hy yp pe er rc ca ap pn ni ia a G. Scano*, A. Spinelli*, R. Duranti*, M. Gorini**, F. Gigliotti**, P. Goti*, J. Milic-Emili † Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia. G. Scano, A. Spinelli, R. Duranti, M. Gorini, F. Gigliotti, P. Goti, J. Milic-Emili. ©ERS Journals Ltd 1995. ABSTRACT: To ascertain whether and to what extent the reduced ventilatory response to a hypercapnic stimulus in chronic obstructive pulmonary disease (COPD) patients depends on a blunted chemoresponsiveness of central origin or to mechanical impairment, we studied two groups of COPD patients without (group A) and with (group B) chronic hypercapnia, but with similar degrees of airway obstruction and hyperinflation.The study was performed on 17 patients (9 normocapnic and 8 hypercapnic). Six age-matched normal subjects (group C) were also studied as a control. During a CO 2 rebreathing test, ventilation (VE), mouth occlusion pressure (P0.1), and the electromyographic activity of diaphragm (Edi) were recorded and then plotted against end-tidal carbon dioxide tension (PCO 2 ).Inspiratory muscle strength was significantly lower in the hypercapnic group (group B) compared to normocapnic group (A), and in these groups compared to the control group (C). Both patient groups exhibited significantly lower ∆VE/∆PCO 2 than the control group. In hypercapnics, ∆P0.1/∆PCO 2 was significantly lower than in normocapnics and control group, whilst mouth occlusion pressure as % of maximal inspiratory pressure ∆P0.1(%MIP)/∆PCO 2 did not differ significantly among the three groups. ∆Edi/∆PCO 2 increased from C to A. At a PCO 2 of 8.65 kPa, VE was similar in the normocapnic and control group, but lower in hypercapnics; Edi was similar in hypercapnic and control group; but greater in normocapnics. P0.1(%MIP) did not differ significantly among groups.Although these data seem to suggest that CO 2 chemoresponsiveness was normal in hypercapnic and increased in normocapnic COPD patients, the lower VE at a PCO 2 of 8.65 kPa casts doubts about the adequacy of chemoresponsiveness in the hypercapnic group. In the latter, the reduced P0.1 response in face of normal P0.1(MIP) and Edi responses to carbon dioxide stimulation could suggest an impairment in inspiratory muscle function. Mechanical impairment and inadequate chemoresponsiveness are both likely to contribute to the low ventilatory response to CO 2 stimulation in chronic hypercapnic COPD patients. Eur Respir J., 1995, 8, 78-85

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia

Scano¹,

Spinelli²,

Duranti³

et al. 1995

Eur Respir J

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“…The spectrum of diseases involvement ranges from mild dyspnea to life threatening respiratory failure. Amongst the various mechanisms claimed in pathophysiology of respiratory failure caused by hypothyroidism the reduction in central respiratory drive, respiratory muscle weakness and sleep related breathing disorders are the crucial one [2].…”

Section: Discussionmentioning

confidence: 99%

Myxedema of Upper Airway: A Rare Cause of Stridor

Bidkar¹,

Naik²,

Roshan³

et al. 2013

JCR

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Abstract:Hypothyroidism is known to affect breathing by reducing respiratory drive. Near total narrowing of nasooropharynx and larynx due to myxedema of upper airway in an undiagnosed severe hypothyroidism is a rare phenomenon. We report a case of non goitorous severe hypothyroidism presenting with upper airway obstruction in a 60 year old male-a diagnostic challenge in acute onset airway obstruction. An upper airway myxedema and hypertrophic myopathy of pharyngeal dilator muscles in hypothyroidism can present with severe acute airway compromise in absence of goitorous enlargement of the thyroid gland.

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“…The use of intravenous thyroxine therapy was shown to improve both hypoxic and hypercapnic ventilatory drive within one week of therapy. (Duranti et al, 1993) Severe degrees of alveolar hypoventilation and coma have also been reported in cases of severe hypothyroidism (myxedema). (Behnia et al, 2000, Wall, 2000, Jordan, 1995 Hypothyroidism is reported in 3% of difficult to wean mechanically ventilated patients.…”

Section: Ventilatory Drivementioning

confidence: 99%

“…(Simsek et al, 2004) In humans, approximately, one third of the hypothyroid patients have a blunted 53 ventilatory response to hypoxia/hypercapnia. (Zwillich et al, 1975, Duranti et al, 1993, Massumi RA, 1964 Predictors of blunted ventilatory response in hypothyroidism have been identified as female gender and very high levels of thyrotropin (>90 mIU/l). (Ladenson et al, 1988) It is the severe form of hypothyroidism that is associated with diminished ventilatory control.…”

Section: Ventilatory Drivementioning

confidence: 99%

“…Several pathophysiological mechanisms are responsible for the compromise in the respiratory system including reduction in central respiratory drive, respiratory muscle weakness and sleep-related breathing disorders (SBD). (Duranti et al, 1993, Saaresranta and Polo, 2002, Curnock et al, 1999 Hypothyroidism is characterized by mucopolysaccharides accumulation in the dermis, hypopharynx, tongue and other tissues. (Skatrud et al, 1981 In its most severe form (myxedema), patients typically present with hypothermia, hypercapnia, hypotension and bradycardia.…”

Section: Introductionmentioning

confidence: 99%

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