A Prospective Study on the Prevalence of Pulmonary Artery Hypertension in Thyroid Dysfunction

Abstract

Introduction: Though rare, thyroid dysfunction is known to cause Pulmonary Artery Hypertension (PAH) which is also known to be reversible by restoration of euthyroid state. Hence, timely diagnosis and institution of medications can prevent as well as treat the secondary PAH in these patients. Aim: To analyse the prevalence of PAH in newly diagnosed, treatment naïve patients with thyroid dysfunction (hypothyroidism/hyperthyroidism) and to analyse the association of thyroid dysfunction with occurrence of PAH in treatment naïve patients. Furthermore, to see the improvement of PAH in those diagnosed, with treatment given, after 6 months. Materials and Methods: It was an observational prospective study which included 67 newly diagnosed patients with thyroid dysfunction. All were subjected to 2D echocardiography with detailed history and physical examination. Repeat echocardiographic assessment was done after 6 months of treatment for few patients to look for resolution of PAH. The statistical analysis was carried out to determine the association of PAH with thyroid dysfunction using student’s t-test and chisquare test of association. Results: The study included 56 (84%) females and 11 (16%) males. PAH was present in 19 (28.3%) patients, with a mean age of presentation of 34.3±10.70 years. In the echocardiographic assessment of patients with PAH, tricuspid regurgitation (100%), pericardial effusion (26%), dilatation of right heart chambers (21%), reduced LVEF (16%) and pulmonary regurgitation (5%) were the main findings recorded. Repeat echocardiography after 6 months of treatment (Eltroxin 1.6 microgram/kg for hypothyroid patients and Carbimazole (5/10 mg BD/TDS) for hyperthyroid) was performed in 7 of the 19 patients only (those who were diagnosed with PAH at the time of diagnosis of thyroid dysfunction) and reduction in Pulmonary Artery Systolic Pressure (PASP) was observed in 3 of them. Conclusion: High prevalence (28.3%) of PAH was observed in patients with thyroid dysfunctions at the time of diagnosis in the treatment naïve patients in the current study and it also reversed with treatment in three out of 7 patients on repeat 2D-echo with treatment. It is, therefore, suggested that every patient of thyroid dysfunction should be screened for PAH, even though further studies are needed to substantiate this, due to an inherent small sample size of the study.

Keywords

• hypothyroidism
• hyperthyroidism
• pulmonary artery hypertension
• 2d-echocardiography