Chest
Volume 132, Issue 3, September 2007, Pages 793-797
Journal home page for Chest

ORIGINAL RESEARCH
PULMONARY HYPERTENSION
Pulmonary Hypertension and Thyroid Disease

https://doi.org/10.1378/chest.07-0366Get rights and content

Background

The association between thyroid dysfunction and pulmonary hypertension (PH) has not been well characterized.

Methods

This retrospective study comprised 356 consecutive PH patients seen at Mayo Clinic Jacksonville Pulmonary Hypertension Center from 1992 to 2006 and 698 sex-matched control subjects without PH. Thyroid disease was defined as an abnormal thyroid-stimulating hormone level, with or without an abnormal free or total thyroxine level, a history of thyroid disease on replacement, or an elevated thyroperoxidase antibody level. The main outcome measure was prevalence of thyroid disease in each group.

Results

Median age of the 356 PH patients was 65 years; 230 patients (65%) were female. The control group of 698 patients had the same sex ratio and median age of 68 years. Most PH patients had severe PH, as categorized by World Health Organization (WHO) class (74% class 3–4) and pulmonary artery systolic pressure. Among those with PH, 85 patients (24%) had thyroid disease vs 107 control patients (15%). After adjusting for age and sex, the prevalence of thyroid disease was increased in PH patients compared with control patients. Increased prevalence was most prominent in WHO group 1, pulmonary artery hypertension confirmed by right-heart catheterization (odds ratio, 2.53; 95% confidence interval, 1.55 to 4.08; p < 0.001). Most patients had mild thyroid disease and were hypothyroid. Only 14 of 85 patients (16%) had previously undiagnosed thyroid disease.

Conclusions

Patients with PH have a higher prevalence of thyroid disease than other pulmonary patients. Evaluation of thyroid function in PH patients may be warranted to detect and assess coexisting thyroid disease.

Section snippets

Patients

This study was approved by the Mayo Clinic Institutional Review Board. All patients with PH seen at Mayo Clinic Jacksonville Pulmonary Hypertension Center from 1992 to 2006 were studied retrospectively. A sex-matched control group was randomly selected from a list of patients seen in the Pulmonary Clinic at Mayo Clinic for diseases other than PH. In the study group, 8 of 364 patients were excluded because they had normal right-heart catheterization (RHC) pressures. Of the 700 control patients,

Results

Baseline characteristics of the 356 PH patients, including age, sex, TSH levels, and WHO symptom class, stratified by WHO group, were compared with those of the 698 patients in the control group (Table 1). The entire PH group and WHO group 1 patients were slightly younger. The control group of 698 patients had the same sex ratio as the entire PH group by design; however, the WHO group 1, particularly the IPAH group, had a higher percentage of female patients. The combined WHO groups 2, 3, and 4

Discussion

Our data indicate a prevalence (24%) of thyroid disease in PH similar to that reported in previous studies.41316 Curnock et al13 reported a prevalence of 23% in 40 patients with primary PH. The association was strongest in WHO group 1 PAH patients, most notably in our group of IPAH patients, in whom the prevalence was 30%. Ferris et al4 retrospectively reviewed 134 adults with PH (most with IPAH and PAH in association with collagen vascular disease) and found that 26 patients (19%) had thyroid

Conclusions

To our knowledge, this is the first study to have an adequate control group with which to compare PH patients regarding the prevalence of thyroid disease, and our findings indicate a difference in the prevalence of thyroid disease between these two groups. Screening for thyroid dysfunction in patients with PH has been advocated as a mechanism to identify possible alternative exacerbating factors.926 The findings of our study support the contention that a significant percentage of PH patients

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    Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.

    The authors have no conflicts of interest or financial involvement with this article.

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