甲状腺激素状态与格雷夫斯病肺动脉高压的相互作用：在甲状腺毒症和甲状腺功能正常患者中的评估相关性。
Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves' Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients.
机构信息
Endocrinology Division, Department of Internal Medicine, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
Cardiology Division, Department of Internal Medicine, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
出版信息
Front Endocrinol (Lausanne). 2022 Jan 6;12:780397. doi: 10.3389/fendo.2021.780397. eCollection 2021.
BACKGROUND
Graves' disease (GD) is the most common cause of hyperthyroidism and can cause cardiac changes, such as pulmonary hypertension.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
背景
格雷夫斯病（GD）是甲状腺功能亢进症最常见的原因，可引起心脏改变，如肺动脉高压。
方法
这是一项前瞻性研究，我们获得了人口统计学、临床、实验室数据以及 GD 的特征，除了调查心肺功能外，还重点检测肺动脉高压。患者分为两组：甲状腺毒症和甲状腺功能正常。共纳入 90 例年龄在 18 岁以上的男女 GD 患者。心肺评估包括超声心动图评估、特定症状问卷、肺功能检查和 6 分钟步行试验。
结果
甲状腺毒症组 42 例（47.73%），甲状腺功能正常组 46 例（52.27%）；78 例为女性（86.67%）。甲状腺毒症组（48.57%）和甲状腺功能正常组（29.41%）之间的肺动脉高压发生率无差异。游离甲状腺素（FT4）水平（OR 1.266）、左心房容积增大（OR 1.113）和右心室直径与肺动脉高压相关。在甲状腺功能正常组中，FT4 与用力肺活量（FVC）和第一秒用力呼气量（FEV1）呈正相关，初始血氧饱和度（SpO2）与诊断时间呈负相关，SpO2 下降与二尖瓣血流舒张速度 E 与二尖瓣环舒张速度的比值（E/e'）呈负相关。在甲状腺毒症组中，FT4 水平与预测值百分比的步行距离呈负相关，E/e'比值与预测值百分比的步行距离呈正相关。
结论
我们强调即使在甲状腺功能亢进状态长期控制后，也应对 GD 进行心肺再评估，因为我们发现约 30%的这些患者仍存在 PH，并需要接受特定治疗。
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