Thyroid-stimulating hormone and mortality in pulmonary arterial hypertension

Abstract

IntroductionPulmonary arterial hypertension (PAH) remains a serious and life-threatening illness. Thyroid dysfunction is relatively understudied in individuals with PAH but is known to affect cardiac function and vascular tone in other diseases. The aim of this observational study was to evaluate the association between thyroid-stimulating hormone (TSH), mortal and non-mortal outcomes in individuals with PAH.MethodsThe Seattle Right Ventricle Translational Science (Servetus) Study is an observational cohort that enrolled participants with PAH between 2014 and 2016 and then followed them for 3 years. TSH was measured irrespective of a clinical suspicion of thyroid disease for all participants in the cohort. Linear regression was used to estimate the relationships between TSH and right ventricular basal diameter, tricuspid annular plane systolic excursion and 6-minute walk distance. Logistic regression was used to estimate the relationship with New York Heart Association Functional Class, and Cox proportional hazards were used to estimate the relationship with mortality. Staged models included unadjusted models and models accounting for age, sex at birth and aetiology of pulmonary hypertension with or without further adjustment for N-terminal-pro hormone brain natriuretic peptide.ResultsAmong 112 participants with PAH, TSH was strongly associated with mortality irrespective of adjustment. There was no clear consistent association between TSH and other markers of severity in a cohort with PAH.DiscussionThis report reinforces the important observation that TSH is associated with survival in patients with PAH, and future study of thyroid dysfunction as a potential remediable contributor to mortality in PAH is warranted.

Clinical features and long-term survival in idiopathic pulmonary arterial hypertension with thyroid dysfunction: insights from a national multicentre prospective study

“…Studies have shown that thyroid abnormalities can be seen in critically ill patients [20,21]. It seems that the presence of subclinical hypothyroidism is more likely to be a pathophysiological manifestation in the advanced course of IPAH, as a part of multiorgan dysfunction, or associated with systemic stress or systemic vulnerability in critical patients, as indicated in the recent work of Pi et al [22]. This can also explain the worst prognosis of patients with subclinical hypothyroidism among patients with thyroid dysfunction, despite relatively aggressive treatment of PAH.…”

Association of red cell distribution width with pulmonary arterial hypertension in patients with mixed connective tissue disease

“…FT3 was significantly decreased in MCTD-PAH patients, while TSH was significantly higher in the MCTD-PAH group. The literature suggests that thyroid dysfunction is associated with PAH [ 33 ]. Indeed, thyroid hormone impacts cardiac contractility, cardiac output, and pulmonary and systemic vascular resistance [ 20 , 34 ], and up to 20% of patients with PAH also have thyroid disease [ 35 ].…”

Association between serum TSH levels and all-cause mortality in critically ill patients

“…Serum TSH assays that have a detection limit of 0.01 mU/L are considered the most sensitive test for thyroid function in critically ill patients [ 2 ]. High TSH (>4.5 mIU/L) is associated with significantly higher mortality in pulmonary arterial hypertension [ 10 ]. High TSH (≥10 mU/L) subclinical hypothyroidism is associated with increased postoperative mortality, all-cause mortality and cardiac death in acute type A aortic dissection patients who underwent aortic surgery [ 11 ].…”