Zuhur Sayid Shafi, Baykiz Derya, Kara Sonat Pinar, Sahin Ertan, Kuzu Idris, Elbuken Gulsah
Department of Endocrinology and Metabolism, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
Cardiology Clinic, Tekirdag Government Hospital, Tekirdag, Turkey.
Am J Med Sci. 2017 Apr;353(4):374-380. doi: 10.1016/j.amjms.2017.01.016. Epub 2017 Feb 1.
Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism.
A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT.
Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves׳ disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels.
Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHT; however, severe dyspnea requires further evaluation.
既往研究报道了关于甲状腺功能亢进症患者肺动脉高压（PHT）病理生理学潜在机制的相互矛盾的结果。因此，在本研究中，我们调查了大量甲状腺功能亢进症患者中PHT与促甲状腺激素（TSH）受体抗体、甲状腺过氧化物酶抗体、甲状腺球蛋白抗体、TSH、游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）以及日常活动中的呼吸困难之间的关联。
本研究共纳入了129例连续的甲状腺功能亢进症患者、37例甲状腺功能减退症患者和38例甲状腺功能正常的对照者。采用改良的医学研究委员会量表评估日常活动中的呼吸困难情况。所有患者和甲状腺功能正常的对照者均接受经胸超声心动图检查以评估PHT。
格雷夫斯病、毒性多结节性甲状腺肿、甲状腺功能减退症患者及甲状腺功能正常的对照者中，分别有35%、36%、13.5%和5%存在轻度PHT。伴有PHT的甲状腺功能亢进症患者的肺血管阻力（PVR）高于无PHT的患者。此外，在甲状腺功能亢进症患者中，改良的医学研究委员会量表与肺动脉收缩压及PVR之间存在显著正相关。未发现PHT与血清TSH受体抗体、甲状腺过氧化物酶抗体、甲状腺球蛋白抗体、TSH、fT3和fT4水平之间存在关联。
无论病因如何，相当比例的甲状腺功能亢进症患者存在轻度PHT。PVR似乎是甲状腺功能亢进症患者PHT的主要原因，并且自身免疫和甲状腺激素均与这些患者的PHT无关。甲状腺功能亢进症患者日常活动中的轻度呼吸困难可能与PHT有关；然而，严重呼吸困难需要进一步评估。
