Characteristics and Risk Factors of Pulmonary Hypertension in Patients With Hyperthyroidism

Song, Xiaoqing; Yang, Kun; Chen, Guangzhi; Wu, Du-An; Yao, Di; Li, Shengzhong; Yuan, Gang; Liu, Li

doi:10.1016/j.eprac.2021.02.011

Cited by 10 publications

(5 citation statements)

References 37 publications

(37 reference statements)

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“…Possible mechanisms include endothelial injury due to increased cardiac output, elevated pulmonary vascular resistance induced by increased metabolism of intrinsic pulmonary vasodilating substances, and autoimmune-mediated endothelial remodelling 11. Recent studies have suggested that high free T4 and/or TRAb levels are risk factors for PH due to hyperthyroidism 5 12 13. However, in our patient with severe PH, TRAb was positive but at relatively low levels.…”

Section: Discussionmentioning

confidence: 51%

Symptomatic and severe pulmonary hypertension due to hyperthyroidism

Itagaki

Miura²,

Kasai³

et al. 2022

BMJ Case Rep

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Hyperthyroidism has been recognised as the cause of secondary pulmonary hypertension (PH). However, several studies have reported that most PH cases due to hyperthyroidism are asymptomatic and not severe. Here, we report the case of a woman in her 30s with symptomatic and severe PH due to hyperthyroidism. She presented with a 2-month history of dyspnoea on exertion, palpitation and lower-extremity oedema. Echocardiography showed severe PH with estimated pulmonary arterial systolic pressure (ePASP) of 62 mm Hg. The diagnostic work-up showed severe PH due to hyperthyroidism. After treatment for hyperthyroidism, improvement of thyroid function contributed to a decrease in ePASP to 30 mm Hg. Similar to the present case, PH due to hyperthyroidism generally improves with the treatment of hyperthyroidism. Therefore, we must not overlook hyperthyroidism as a cause of PH and diagnose and start treatment for PH-causing hyperthyroidism at an early stage.

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Section: Discussionmentioning

confidence: 51%

Symptomatic and severe pulmonary hypertension due to hyperthyroidism

Itagaki

Miura²,

Kasai³

et al. 2022

BMJ Case Rep

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“…However, they did report higher T4 levels to be significantly associated with the development of PHTN. [ 14 ] In our review’s patient population (PHTN with HTH), TSH, T3, or T4 levels did not show any statistically significant association with outcomes of PHTN. This could indicate that although a more severe HTH is associated with PHTN, once it develops, the severity of HTH does not affect the reversibility of PHTN.…”

Section: Discussionmentioning

confidence: 64%

“…There are multiple retrospective studies, but mostly with small sample sizes; hence, the results have not been consistent. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Some studies have shown an association of hormone levels such as free thyroxine (FT [4] ), and antibodies such as TRAB with increased pulmonary pressures, whereas other studies did not find this association. [12,15,16,[18][19][20] Additionally, the pathophysiology of PHTN in HTH remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Additionally, increased TB was an independent predictor of PH in COPD patients living at HA and LA; COPD-PH patients from HA had significantly higher TB than those from LA. Similarly, some studies on TB and PH reported that PASP levels were positively correlated with TB, and TB was an independent predictor of PH, [ 67 , 68 ] the reasons could be that HA is characterized by hypoxia and bilirubin is an endogenous antioxidant molecule related to oxidative stress [ 69 , 70 ]. Moreover, in our study, transaminases between COPD-PH at HA and COPD-PH at LA were not significantly different, indicating that serum bilirubin was more sensitive to hemodynamic changes than transaminases, [ 71 ] however, the sensitivity of serum bilirubin and transaminases to altitude changes were required for assessment in more studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and predictors of pulmonary hypertension in chronic obstructive pulmonary disease at different altitudes

Wang

Tuo

et al. 2023

BMC Pulm Med

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Background Pulmonary hypertension (PH) is a common complication in patients with chronic obstructive pulmonary disease (COPD) and is closely associated with poor prognosis. However, studies on the predictors of PH in COPD patients are limited, especially in populations living at high altitude (HA). Objectives To investigate the differences in the clinical characteristics and predictors of patients with COPD/COPD and PH (COPD-PH) from low altitude (LA, 600 m) and HA (2200 m). Methods We performed a cross-sectional survey of 228 COPD patients of Han nationality admitted to the respiratory department of Qinghai People’s Hospital (N = 113) and West China Hospital of Sichuan University (N = 115) between March 2019 and June 2021. PH was defined as a pulmonary arterial systolic pressure (PASP) > 36 mmHg measured using transthoracic echocardiography (TTE). Results The proportion of PH in COPD patients living at HA was higher than that in patients living at LA (60.2% vs. 31.3%). COPD-PH patients from HA showed significantly different in baseline characteristics, laboratory tests and pulmonary function test. Multivariate logistic regression analysis indicated that the predictors of PH in COPD patients were different between the HA and LA groups. Conclusions The COPD patients living at HA had a higher proportion of PH than those living at LA. At LA, increased B-type natriuretic peptide (BNP) and direct bilirubin (DB) were predictors for PH in COPD patients. However, at HA, increased DB was a predictor of PH in COPD patients.

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Characteristics and Risk Factors of Pulmonary Hypertension in Patients With Hyperthyroidism

Cited by 10 publications

References 37 publications

Symptomatic and severe pulmonary hypertension due to hyperthyroidism

Symptomatic and severe pulmonary hypertension due to hyperthyroidism

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

Clinical characteristics and predictors of pulmonary hypertension in chronic obstructive pulmonary disease at different altitudes

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