Hipertensão arterial pulmonar e doenças da tireoide

Silva, Denise Rossato; Gazzana, Marcelo Basso; John, Angela Beatriz; Siqueira, Débora Rodrigues; Maia, Ana Luiza Silva; Barreto, Sérgio Saldanha Menna

doi:10.1590/s1806-37132009000200012

Cited by 30 publications

(6 citation statements)

References 28 publications

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“…Thyroid disorders are classified as mechanisms for the development of Group 5 PH 8 ; however, thyroid disease is also commonly observed concomitantly in patients with PAH (either present during the initial assessments or developing during the course of PAH) 10 , 58 . In both hypothyroidism and hyperthyroidism, cardiac output and pulmonary vascular resistance (PVR) are increased, which in turn can act as a driver for PH 59 , 60 .…”

Section: Management Considerations With Comorbidities and Pulmonary Amentioning

confidence: 99%

The burden of comorbidities in pulmonary arterial hypertension

Lang

Palazzini

2019

European Heart Journal Supplements

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Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities.

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Section: Management Considerations With Comorbidities and Pulmonary Amentioning

confidence: 99%

The burden of comorbidities in pulmonary arterial hypertension

Lang

Palazzini

2019

European Heart Journal Supplements

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“…Intraventricular conduction delay in the form of right bundle branch block is present in around 15% of patients, and atrioventricular block may also occur due to unknown reasons. Increased dispersion of QT interval corrected by the heart rate (QTcD) and pulmonary hypertension may also be observed, but their mechanisms are not clear; the same cardiac and hemodynamic changes together with autoimmunity in Graves’ patients may have a role [ 67 , 68 ]. Hyperthyroidism is associated with shortened action potential and increased expression of L-type calcium channel 1D, enhances Na and K permeability, and affects Na pump density [ 69 ].…”

Section: Overt Hyperthyroidismmentioning

confidence: 99%

State of the art paper Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology

Ertek¹,

Cicero²

2013

aoms

118

107

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Cardiovascular complications are important in hyperthyroidism because of their high frequency in clinical presentation and increased mortality and morbidity risk. The cause of hyperthyroidism, factors related to the patient, and the genetic basis for complications are associated with risk and the basic underlying mechanisms are important for treatment and management of the disease. Besides cellular effects, hyperthyroidism also causes hemodynamic changes, such as increased preload and contractility and decreased systemic vascular resistance causes increased cardiac output. Besides tachyarrythmias, impaired systolic ventricular dysfunction and diastolic dysfunction may cause thyrotoxic cardiomyopathy in a small percentage of the patients, as another high mortality complication. Although the medical literature has some conflicting data about benefits of treatment of subclinical hyperthyroidism, even high-normal thyroid function may cause cardiovascular problems and it should be treated. This review summarizes the cardiovascular consequences of hyperthyroidism with underlying mechanisms.

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“…In fact, evidence for such an association exists. Thus, thyroid dysfunctions are for example associated with pulmonary hypertension [ 13 ]. It has also been demonstrated that hyperthyroidism is accompanied by a reduced muscle strength resulting in impaired ventilation under exercise [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Serum thyroid-stimulating hormone levels are not associated with exercise capacity and lung function parameters in two population-based studies

Ittermann¹,

Gläser

Ewert

et al. 2014

BMC Pulm Med

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BackgroundThyroid dysfunction has been described to be linked to a variety of cardiovascular morbidities. Through this pathway thyroid function might also be associated with cardiorespiratory function and exercise capacity. So far only few patient-studies with small study populations investigated the association between thyroid dysfunction and exercise capacity. Thus, the aim of our study was to investigate the association of serum thyroid-stimulating hormone (TSH) levels with lung function and cardiopulmonary exercise testing (CPET) in the general population.MethodsData from the two independent cross-sectional population-based studies (Study of Health in Pomerania [SHIP] and SHIP-Trend-0) were pooled. SHIP was conducted between 2002 and 2006 and SHIP-Trend-0 between 2008 and 2012. Participants were randomly selected from population registries. In total, 4206 individuals with complete data were available for the present analysis. Thyroid function was defined based on serum TSH levels. Lung function was evaluated by forced expiratory volume in 1 s and forced vital capacity. CPET was based on symptom limited exercise tests on a bicycle in a sitting position according to a modified Jones protocol. Associations of serum TSH levels with lung function and CPET parameters were analysed by multivariable quantile regression adjusted for age, sex, height, weight, use of beta blockers, smoking status, and physical activity.ResultsSerum TSH levels, used as continuously distributed variable and categorized according to the clinical cut-offs 0.3 and 3.0 mIU/L or according to quintiles, were not consistently associated with parameters of lung function or CPET.ConclusionsOur results suggest that thyroid dysfunction is not associated with lung function and cardiopulmonary exercise capacity in the general population.

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Hipertensão arterial pulmonar e doenças da tireoide

Cited by 30 publications

References 28 publications

The burden of comorbidities in pulmonary arterial hypertension

The burden of comorbidities in pulmonary arterial hypertension

State of the art paper Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology

Serum thyroid-stimulating hormone levels are not associated with exercise capacity and lung function parameters in two population-based studies

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