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Heart, Lung and Circulation

Prospective Echocardiographic Evaluation of the Right Ventricle and Pulmonary Arterial Pressure in Hyperthyroid Patients

  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    M.L. Gazzana
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Superior School of Health Sciences, Amazonas State University − UEA, Manaus, Amazonas, Brazil
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  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    J.J. Souza
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Medical School, Amazonas Federal University − UFAM, and Medical School, Nilton Lins University − UNL, Manaus, Amazonas, Brazil
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  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    M.P. Okoshi
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University − UNESP, Botucatu, Sao Paulo, Brazil
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  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    K. Okoshi
    Correspondence
    Corresponding author at: Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP. CEP 18618-687 Botucatu, SP, Brazil.
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University − UNESP, Botucatu, Sao Paulo, Brazil
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Published:August 01, 2018DOI:https://doi.org/10.1016/j.hlc.2018.06.1055

      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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