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Thyrotoxicosis as a Risk Factor for Pulmonary Arterial Hypertension
Lewis J. Rubin, MD, and
David B. Badesch, MD
7 February 2006 | Volume 144 Issue 3 | Pages 222-223
IN RESPONSE:
We agree with Drs. Ma and Chow that there is some justification for screening patients with PAH for thyroid dysfunction. We were among the first to make the observation that thyroid abnormalities might occur with increased frequency in patients with PAH (1). In that report, we speculated that there might be a common underlying autoimmune disorder. The concept that antithyroid antibodies could play a role in the pathogenesis of PAH is indeed quite intriguing, and there have been several subsequent reports of hypothyroidism and hyperthyroidism occurring in patients with pulmonary hypertension (2-5), although a causal relationship has not been proven.
Regardless of whether thyroid disease and PAH share a common pathogenic mechanism, their frequent coexistence is important to recognize; thyroid disease produces cardiovascular stresses that are poorly tolerated in the setting of PAH and should therefore be treated aggressively. However, ß-blockers, which are commonly used as adjunct therapy in hyperthyroidism, may precipitate worsening of right ventricular dysfunction and should be avoided or used very cautiously.
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Author and Article Information
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Form the University of California, San Diego, La Jolla, CA 92093, and the University of Colorado Health Sciences Center, Denver, CO 80262.
Potential Financial Conflicts of Interest: None disclosed.
1. Badesch DB, Wynne KM, Bonvallet S, Voelkel NF, Ridgway C, Groves BM. Hypothyroidism and primary pulmonary hypertension: an autoimmune pathogenetic link? Ann Intern Med. 1993;119:44-6. [PMID: 8498763].[Abstract/Free Full Text]
2. Arroliga AC, Dweik RA, Rafanan AL. Primary pulmonary hypertension and thyroid disease [Letter]. Chest. 2000;118:1224-5. [PMID: 11035704].[Free Full Text]
3. Curnock AL, Dweik RA, Higgins BH, Saadi HF, Arroliga AC. High prevalence of hypothyroidism in patients with primary pulmonary hypertension. Am J Med Sci. 1999;318:289-92. [PMID: 10555089].[Medline]
4. Ferris A, Jacobs T, Widlitz A, Barst RJ, Morse JH. Pulmonary arterial hypertension and thyroid disease [Letter]. Chest. 2001;119:1980-1. [PMID: 11399743].[Free Full Text]
5. Kashyap AS, Kashyap S. Thyroid disease and primary pulmonary hypertension [Letter]. JAMA. 2001;285:2853-4. [PMID: 11401596].[Free Full Text]
Related articles in Annals:
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Brief Reports
Hypothyroidism and Primary Pulmonary Hypertension: An Autoimmune Pathogenetic Link?
David B. Badesch, Kristine M. Wynne, Scott Bonvallet, Norbert F. Voelkel, Chester Ridgway, AND Bertron M. Groves
- Annals 1993 119: 44-46.
[ABSTRACT][Full Text]
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