The clinical characteristics and outcomes of patients with pulmonary hypertension in association with hyperthyroid state: A systematic review

Abstract

Background: Pulmonary hypertension (PHTN) may occur in thyroid disorders, especially in hypothyroidism. However, there is increasing evidence of PHTN in hyperthyroidism (HTH). The etiology, clinical course, management, and factors associated with outcomes of PHTN in the setting of HTH are unascertained. This systematic review consolidates available evidence on patients with HTH who developed PHTN. Methods: We conducted a systematic review on English articles from PubMed, Scopus, and Google Scholar reporting PHTN in patients with hyperthyroidism. Data were analyzed and reported in Microsoft Excel 2020, SPSS version 26, and Jamovi version 1.2. Results: We identified 589 patients with PHTN in the setting of HTH. Etiologies included Grave disease 66.7%), toxic multinodular goiter (TMNG) (16.8%), drug-induced HTH (0.3%), thyroiditis(0.8%), and toxic adenoma(0.1%). Most patients did not receive any specific management for PHTN and were managed by antithyroid treatment (97.4%). Outcomes of PHTN were reported in 181 patients, with a 94% recovery rate. Pulmonary artery pressures (PAP) before and after HTH management ranged from 22.5 to 75 mm Hg and from 24 to 50 mm Hg, respectively. Outcome analysis performed on data from case reports and series with individually identifiable data revealed a 67.6% female preponderance. An estimated 73.5% of the patients had PHTN at the initial presentation of HTH, which was associated with a better resolution rate of PHTN(OR: 12, P -value: 0.048). TRAB was positive in 47% patients with no clinical difference in outcomes. antiTG AB was reported positive in 29.4%, all of whom had an improvement, compared to an 83.3% improvement rate in those with negative antiTG AB. Various etiologies and treatments did not have any significant differences in the outcome of PHTN. Conclusions: PHTN can be present at the initial diagnosis of HTH, which is associated with better outcomes of PHTN. There is a clear female preponderance in the development of PHTN. However, resolution rates seem to be better in males. Although TRAB is associated with the development of PHTN, it does not seem to affect the outcomes. PHTN in patients with HTH does not need any specific management, with >90% resolution with antithyroid therapy. Whether any specific antithyroid therapy has a better outcome in PHTN needs to be explored prospectively.

Pulmonary Hypertension Associated With Hyperthyroidism: A Case Report

“…Evaluation of thyroid function in PH patients may be warranted to detect and assess coexisting thyroid disease, although it may sometimes be missed. In a systematic review that included 589 patients with PH and hyperthyroidism, the etiologies were Graves’ disease (66.7%) as shown in our case, toxic multinodular goiter (16.8%), and thyroiditis (0.8%) [ 4 ]. It is important to note that not only hyperthyroidism but also hypothyroidism can be related to PH.…”

“…The precise mechanism is not fully investigated and may be multifactorial. The proposed mechanisms are the direct effects of thyroid hormones on pulmonary vascular proliferation, the chronotropic effects of hormones on the cardiovascular system, and autoimmune-mediated endothelial dysfunction [ 4 , 5 ]. An echocardiographic examination showed that female patients with hyperthyroidism, like the present case, had elevated cardiac output and pulmonary vascular resistance [ 6 ].…”

Atrioventricular block in patients with hyperthyroidism: a narrative review

“…17 High-output cardiac failure, dilated cardiomyopathy, right heart failure, and pulmonary hypertension are other uncommon cardiac complications of HTH. 18,19 When HTH results in these complications or when these comorbid conditions are coupled with HTH, the risk of mortality significantly increases. Patients with HTH who develop cardiac failure have a mortality rate of up to 60% higher than that of patients with euthyroidism.…”

Cardiovascular Complications of Hyperthyroidism

“…Thyroid hormones work as transcription factors, and both the heart and blood arteries have thyroid hormone receptors [3,4]. Changes in the gene expression of cardiovascular system components can have profound effects on the contractile apparatus and sarcoplasmic reticulum of the myocardium [1,5]. In addition, an increase or decrease in the concentration of these hormones affects the cardiovascular system's function [1,6].…”