Hyperthyroidism and pulmonary hypertension

Objectives. To identify patients with hyperthyroidism and coincidental pulmonary hypertension and to document reversibility of pulmonary hypertension after treatment of hyperthyroidism. Design. Patients with hyperthyroidism referred for transthoracal echocardiography for any reason that showed elevated pulmonary arterial pressures were collected. After therapy for the thyreotoxic state with documented normalization of thyroid hormone (fT4), pulmonary arterial pressure was measured again noninvasively. Setting. An out-patient tertiary referral centre. Subjects. The medical records were used to identify, retrospectively patients with hyperthyroidism and pulmonary hypertension over a three-year period (April 1993 to April 1996). Interventions and main outcome measures. Systolic pulmonary artery pressure (PAPs) was determined by adding up right ventricular systolic pressure (RVSP) and mean right atrial pressure (RAP) measured by continuous-wave Doppler echocardiography according to standard techniques. All patients were treated for hyperthyroidism to normal fT4 levels. After successful therapy, Doppler echocardiography was repeated. Results. Four patients with pulmonary hypertension showing elevated PAPs of 40 +/- 11 mmHg were identified. After therapy, PAPs decreased in all patients to a mean of 25 +/- 6 mmHg. Conclusion. The observation of four patients with pulmonary hypertension and hyperthyroidism is striking and suggests a possible pathogenetic link of these disorders.