Pulmonary Hypertension in Men with Thyrotoxicosis

Abstract

Thyrotoxicosis has a myriad of respiratory symptoms including dyspnea. Pulmonary hypertension may contribute to the respiratory symptoms of thyrotoxicosis, but is often unrecognized. We describe 3 male patients with thyrotoxicosis and associated pulmonary hypertension. Case reports of an additional 15 patients are also reviewed. In patients with thyrotoxicosis and pulmonary hypertension, treatment of thyrotoxicosis alone is associated with improvement in pulmonary hypertension. Previous reports have consisted of mostly female patients, but we report 3 men. When all cases are considered, the typical patient is female (10/14 = 71%), middle-aged (48 years), with mean pulmonary artery systolic pressures improving from 56 to 32 mm Hg with treatment. Autoantibodies were detected in 10/14 (71%) patients. The response to treatment (medical or surgical) of thyrotoxicosis supports the hypothesis that hyperthyroidism is either a cause of pulmonary hypertension, or a factor that may unmask pulmonary hypertension. Recognition is important since treatment and response are very different compared to other patients with pulmonary hypertension. This association may not be readily considered in men, since most reports have been of women.

Pulmonary Hypertension in Patients with Chronic Renal Failure

“…Because of the range of medical conditions and environmental exposures associated with pulmonary arterial hypertension, it is difficult to envision a unifying pathogenic mechanism. Although there are probably genetic determinants, environmental exposures and acquired disorders that predispose the patients to pulmonary arterial hypertension, it is clear that none of the factors alone are sufficient to activate the pathways essential for the development of this vascular disease [10, 11]. PH involves vasoconstriction and obliteration of the lumen of small vessels in the lungs by plexiform lesions resulting in increased resistance to flow.…”

Pulmonary hypertension and thyrotoxicosis

“…12 Our second patient, who presented with the most severe degree of right heart failure and hyperthyroidism, was a male.…”

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

“…3 Possible mechanism includes High cardiac outputinduced or autoimmune-induced pulmonary vascular endothelial injury which may lead to pulmonary hypertension. [4][5][6][7][8] Increased pulmonary vascular resistance could also result from increased metabolism of intrinsic pulmonary vasodilating substances (prostacyclin and nitricoxide). 8,9 The regression of pulmonary hypertension following attainment of euthyroid state may support this mechanism.…”