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Thyrotoxicosis as a Risk Factor for Pulmonary Arterial Hypertension
- Lewis J. Rubin, MD; and
- David B. Badesch, MD
- Form the University of California, San Diego, La Jolla, CA 92093, and the University of Colorado Health Sciences Center, Denver, CO 80262.
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, β-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.
David B. Badesch, MD
University of Colorado Health Sciences Center
Denver, CO 80262
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
