Superior School of Health Sciences, Amazonas State University - UEA, Manaus, Amazonas, Brazil.
Medical School, Amazonas Federal University - UFAM, and Medical School, Nilton Lins University - UNL, Manaus, Amazonas, Brazil.
Heart Lung Circ. 2019 Aug;28(8):1190-1196. doi: 10.1016/j.hlc.2018.06.1055. Epub 2018 Sep 12.
Pulmonary arterial hypertension (PAH) occurs in 35% to 65% of hyperthyroid patients. Despite this high frequency, only a few authors have examined the effects of hyperthyroidism treatment on PAH and the right ventricle. We evaluated the effects of hyperthyroidism and its reversal on cardiovascular structure and function using Doppler echocardiography.
We prospectively evaluated 32 patients (42.5±11.9years old) with thyrotoxicosis. Exclusion criteria included previous cardiovascular disease. An echocardiogram was performed at the time of hyperthyroidism diagnosis and after normalisation of free thyroxine (T4) levels. Patients were divided into two groups according to the presence or absence of PAH at the diagnosis, or at two moments, before and after T4 normalisation.
Graves' disease was the most frequent aetiology (75%) of hyperthyroidism. Pulmonary arterial hypertension was observed in 43.8% of patients. Free T4 concentration was higher in PAH than non-PAH patients. Free T4 normalised after 5 (2.0-10.5; median and percentiles) months of treatment. Cardiac chamber sizes and cardiac output were higher in PAH. Right ventricular (RV) systolic function was impaired in PAH. Cardiac output and free T4 (r=0.42; p<0.05) correlated with pulmonary artery systolic pressure (PASP). Cardiac chamber size, cardiac output, left ventricular ejection fraction, and PASP (34.0±8.6 to 21.7±4.5mmHg) reduced after treatment. Right ventricular myocardial performance index and fractional area change improved after T4 normalisation.
Pulmonary arterial hypertension is highly prevalent in hyperthyroid patients and is combined with increased cardiac chambers size and cardiac output, and impaired RV function. Cardiovascular changes are reversible after T4 normalisation in patients without cardiovascular disease.
甲状腺功能亢进症（甲亢）患者中有 35%~65%会发生肺动脉高压（PAH）。尽管这种发生率很高，但只有少数作者研究过甲亢治疗对 PAH 和右心室的影响。我们使用多普勒超声心动图评估了甲亢及其逆转对心血管结构和功能的影响。
我们前瞻性评估了 32 例（42.5±11.9 岁）甲亢患者。排除标准包括既往心血管疾病。在甲亢诊断时和游离甲状腺素（T4）水平正常后进行超声心动图检查。根据 PAH 在诊断时或 T4 正常化前后的存在或不存在，将患者分为两组。
格雷夫斯病是甲亢最常见的病因（75%）。43.8%的患者存在 PAH。PAH 患者的游离 T4 浓度较高。游离 T4 在治疗 5（2.0-10.5；中位数和百分位数）个月后恢复正常。PAH 患者的心脏腔室大小和心输出量较高。PAH 患者的右心室（RV）收缩功能受损。心输出量和游离 T4（r=0.42；p<0.05）与肺动脉收缩压（PASP）相关。心脏腔室大小、心输出量、左心室射血分数和 PASP（34.0±8.6 至 21.7±4.5mmHg）在治疗后降低。游离 T4 正常化后 RV 心肌做功指数和节段面积变化改善。
甲亢患者中 PAH 发生率很高，且伴有心脏腔室增大、心输出量增加和 RV 功能障碍。无心血管疾病的患者，在 T4 正常化后心血管变化是可逆的。
