Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves' Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients

Graves' disease (GD) is the most common cause of hyperthyroidism and can cause cardiac changes, such as pulmonary hypertension. This is a prospective study in which we obtained demographic, clinical, laboratory data and characteristics of the GD, in addition to investigating cardiorespiratory f...

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Published in:	Frontiers in endocrinology (Lausanne) Vol. 12; p. 780397
Main Authors:	Araruna, Larisse Vieira Mendes, de Oliveira, Daniela Camargo, Pereira, Mônica Corso, Moura Neto, Arnaldo, Tambascia, Marcos Antonio, Zantut-Wittmann, Denise Engelbrecht
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 06-01-2022
Subjects:	Adult Aged autoimmune thyroid disease Blood Flow Velocity Case-Control Studies Echocardiography Endocrinology Female Forced Expiratory Volume Graves Disease - blood Graves Disease - epidemiology Graves Disease - physiopathology Graves Disease - therapy Graves’ disease Heart Atria - diagnostic imaging Heart Atria - pathology Heart Ventricles - diagnostic imaging Heart Ventricles - pathology Humans Hypertension, Pulmonary - blood Hypertension, Pulmonary - diagnostic imaging Hypertension, Pulmonary - epidemiology Hypertension, Pulmonary - physiopathology hyperthyroidism Male Middle Aged Mitral Valve Organ Size pulmonary hypertension Spirometry thyroid hormone Thyrotoxicosis - blood Thyrotoxicosis - epidemiology Thyrotoxicosis - physiopathology Thyrotropin - blood Thyroxine - blood Triiodothyronine - blood Vital Capacity Walk Test Young Adult autoimmune thyroid disease hyperthyroidism thyroid hormone Graves’ disease pulmonary hypertension
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Summary:	Graves' disease (GD) is the most common cause of hyperthyroidism and can cause cardiac changes, such as pulmonary hypertension. This is a prospective study in which we obtained demographic, clinical, laboratory data and characteristics of the GD, in addition to investigating cardiorespiratory function, focusing on the detection of pulmonary hypertension. Patients were separated into two groups: thyrotoxicosis and euthyroidism. Ninety patients with GD of both sexes, over 18 years of age, were included. The cardiorespiratory assessment included an echocardiographic evaluation, a questionnaire of specific symptoms, spirometry and a six-minute walk test. The hyperthyroid group included 42 patients (47.73%) and the euthyroid group 46 patients (52.27%); 78 were women (86.67%). The prevalence of pulmonary hypertension between the hyperthyroidism (48.57%) and the euthyroidism (29.41%) groups was not different. Free thyroxine levels (FT4) (OR 1.266), higher left atrium volume (OR 1.113) and right ventricle diameter were associated with pulmonary hypertension. A direct correlation between FT4 with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as also an inverse correlation between initial oxygen saturation (SpO2) with diagnostic time and drop SpO2 with the ratio between the diastolic velocity E of the mitral flow and the diastolic velocity of the mitral ring (E/e') were observed in the euthyroid group. An inverse correlation between FT4 levels with walked distance as % of predicted value, and a direct correlation between E/e' ratio and walked distance as % of predicted value were observed in the hyperthyroid group. We emphasize the importance of a cardiorespiratory reassessment in GD, even after a long-term control of the thyrotoxic state, as we demonstrate that about 30% of these patients remain with PH and are subject to specific treatment.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 This article was submitted to Thyroid Endocrinology, a section of the journal Frontiers in Endocrinology Reviewed by: Giorgio Napolitano, University of Studies G. d’Annunzio Chieti and Pescara, Italy; Serena Ippolito, ASL Napoli 1 Centro, Italy Edited by: Bernadette Biondi, University of Naples Federico II, Italy
ISSN:	1664-2392 1664-2392
DOI:	10.3389/fendo.2021.780397