Cardiovascular abnormalities in hyperthyroidism: A prospective Doppler echocardiographic study

Thyroid Disease and the Heart

“…54 Both pulmonary hypertension and atrioventricular valve regurgitation have been documented to occur with a surprisingly high prevalence. 59,60 Several case reports have documented that hyperthyroidism may present as right heart failure and tricuspid regurgitation. 61 In a recent study of 23 consecutive patients with hyperthyroidism caused by Graves' disease, 65% of patients had pulmonary hypertension.…”

“…83,91 It is interesting to speculate on the basis of the high prevalence of pulmonary artery hypertension that many of the signs of heart failure, such as neck vein distension and peripheral edema, may be caused by right heart strain. 59,61 Similarly, much of the exercise intolerance and exertional dyspnea in these patients may be the result of decreased pulmonary compliance or decreased respiratory and skeletal muscle function. 4,74 Although initially thought to be contraindicated, treatment of the thyrotoxic cardiac patient with ␤-adrenergic blockade to reduce heart rate should be first-line therapy.…”

Thyrotoxic Cardiomyopathy

“…J. Mercé et al (2005) found higher occurrence of AF in thyrotoxic patients with symptomatic insufficiency of either mitral or tricuspid valves (40% vs. 14%, P=0,02 in mitral regurgitation, and 86% vs. 3%,P=0,01 in tricuspid regurgitation). Data on the effect of thyrotoxicosis intensity (overt or subclinical) are controversial.…”

“…Pulmonary hypertension (PH) (mean pulmonary pressure more than 25 mmHg at rest and more than 30 mmHg at load) is frequently reported at overt thyrotoxicosis. Pulmonary hypertension is often associated with valvular insufficiency (of tricuspid and mitral valves) due to the papillary muscles dysfunction (Whitner et al, 2005;Mercé et al, 2005). Patients with Graves' disease are more likely to have myxomatous degeneration and prolapse of mitral valve as a consequence of endocardium involvement compared to subjects with toxic multinodular goiter (Kahaly, 1987).…”

“…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.…”