Background
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.
Methods
We prospectively evaluated 32 patients (42.5 ± 11.9 years 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.
Results
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 ± 4.5 mmHg) reduced after treatment. Right ventricular myocardial performance index and
fractional area change improved after T4 normalisation.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: August 01, 2018
Accepted:
June 20,
2018
Received in revised form:
May 11,
2018
Received:
January 15,
2018
Identification
Copyright
© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
