Hyperthyroidism as a Cause of Pulmonary Arterial Hypertension: A Prospective Study

Abstract

The authors assessed the prevalence of pulmonary arterial hypertension (PAH) in patients with hyperthyroidism and evaluated the response to treatment of the thyrotoxicosis. They assessed the pulmonary artery systolic pressure (PASP) at rest (estimated by echocardiography) in 23 consecutive patients diagnosed with hyperthyroidism due to Graves' disease or toxic multinodular goiter. Twelve of 23 patients (52%) did not show antithyroglobulin and antithyroperoxidase antibodies. Seventeen patients were followed up for at least 9 months after achieving a stable euthyroid status. Fifteen (65%) patients demonstrated PAH at admission. Four patients were lost to follow-up; therefore they were able to evaluate 17 patients serially with echocardiography. Sixteen patients normalized their PASP value: 13 after methimazole, 2 after total thyroidectomy, and 1 after (131)I treatment. In 1 patient no significant change in PASP was observed. This patient experienced an acute myocardial reinfarction during follow-up. They found a higher prevalence than that previously reported in observational studies. In addition, they demonstrated that the PAH reverses after correction of hyperthyroidism. Elevated PASP at rest on echocardiography may be considered a frequent finding of thyrotoxicosis. Moreover, the data seem not to support an autoimmune pathogenesis for PAH.

MECHANISMS IN ENDOCRINOLOGY: Heart failure and thyroid dysfunction

“…There is a strong relationship between hyperthyroidism and pulmonary hypertension, and hyperthyroid patients may develop right ventricular failure (63,64,65,66,67,68,69,70). In several case reports, isolated right HF, severe right ventricle volume overload and tricuspid regurgitation have been attributed to hyperthyroidism (52,53,64,65,66).…”

Graves' disease presenting as right heart failure with severe pulmonary hypertension

“…Almost all patients normalized the increased pulmonary artery pressure with definitive treatment of the Graves' disease. 31 These studies suggest that isolated right-sided heart failure and pulmonary hypertension are more common than once thought. If an echocardiogram is done routinely on patients with hyperthyroidism, more of these cardiovascular abnormalities may be identified.…”

Thyrotoxic Cardiomyopathy

“…Association between thyrotoxicosis and pulmonary hypertension (PH) has been described as early as in the beginning of 1980s (Mier et al, 1989) and the linking mechanisms are discussed till nowadays (Yanai-Landau et al, 1995;Barst & Loyd, 1998;Menzel et al, 2000;Armigliato et al, 2006). Graves' (autoimmune) disease accounts for the most cases of PH: 47-65% of patients with diffuse goiter have PH (Mercé et al, 2005, Armigliato et al, 2006Yung et al, 2006), such a high prevalence can be explained by both severe form of thyrotoxicosis and autoimmune effects (Yanai-Landau et al, 1995;Chu et al, 2002). The occurrence of PH in subclinical thyrotoxicosis is almost unknown.…”