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The current etiologic classification defines 5 diagnostic groups. Multifactorial mechanisms are encompassed in group 5, including metabolic disorders such as hyperthyroidism.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a patient diagnosed with autoimmune primary hyperthyroidism and severe PHT that improved after control of hyperthyroidism.</p><p id="par0015" class="elsevierStylePara elsevierViewall">54-year-old female patient who came to the emergency room for dyspnoea with minimal exertion. A pulmonary embolism (PE) two years earlier stood out in the medical history. The patient reported a 4-month history of dyspnoea on moderate exertion, aggravated in the last month to be minimal exertion, oedemas in the lower limbs, loss of 20<span class="elsevierStyleHsp" style=""></span>kg, severe fatigue and severe prostration.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A bilateral exophthalmos and grade III multinodular goitre plus signs consistent with heart failure were observed on physical examination.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the symptoms and signs of right heart failure, a transthoracic echocardiography was performed, which revealed a severe PHT with a systolic pulmonary artery pressure (SPAP) above 59<span class="elsevierStyleHsp" style=""></span>mmHg. The patient was admitted to the intensive care unit, given the severity of the situation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lab tests performed in the ICU showed an undetectable thyrotropin (TSH) (0.34–5.6), free triiodothyronine (FT3) of 15.79<span class="elsevierStyleHsp" style=""></span>pg/ml (2.5–3.9) and a free tetraiodothyronine (FT4) of 59.20<span class="elsevierStyleHsp" style=""></span>pg/ml (5.8–16.4). The patient also had severe thrombocytopenia, hypertransaminasemia and coagulopathy data.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Given the personal medical history and present clinical condition, a CT angiography of the pulmonary arteries was performed, which ruled out PTE.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Antithyroid agents, beta blockers and corticosteroids were prescribed to correct thyroid dysfunction, as well as the rest of the usual measures to control heart failure.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A few days later, once the patient was hemodynamically stabilized, a remarkable clinical improvement was observed, with progressive disappearance of heart failure symptoms and signs and a decrease in thyroid hormone levels.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A transthoracic echocardiography performed 14 days after antithyroid treatment initiation continued showing a PHT with SPAP of 55<span class="elsevierStyleHsp" style=""></span>mmHg. At that time, the thyroid profile had improved significantly.</p><p id="par0055" class="elsevierStylePara elsevierViewall">One month after treatment, the patient was asymptomatic. Thyroid hormones were normalized, keeping only a low TSH with normal peripheral hormones (TSH 0.07<span class="elsevierStyleHsp" style=""></span>pg/ml, FT3 3.44<span class="elsevierStyleHsp" style=""></span>pg/ml and FT4 8.10<span class="elsevierStyleHsp" style=""></span>pg/ml). Likewise, platelets, transaminases and the coagulation profile were normalized. An echocardiogram was performed before discharge, which confirmed the normalization of SPAP.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">There is evidence that thyroid dysfunction is common in patients with PHT. Thus, the REVEAL<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> – <span class="elsevierStyleItalic">Registry to Evaluate Early and Long-Term PAH Disease Management</span> – found that 21.6% of patients with PHT had thyroid disease.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Li et al., in a retrospective study, compared 356 patients with PHT with 698 controls matched for age and sex, obtaining a prevalence of thyroid disease of 24% versus 15% of control cases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In 2011, Vallabhajosula et al. published a meta-analysis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> which included a total of 164 patients with PHT without any other cause that would justify it besides thyroid disease. 67% were women and the same percentage was due to hyperthyroidism of autoimmune origin.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mechanism by which this complication occurs is not exactly known. Increased cardiac output and consequent endothelial damage, increased metabolism of pulmonary vasodilators, decreased metabolism of vasoconstrictors and stimulation of the sympathetic system, capable of producing pulmonary vasoconstriction are among the proposed processes, phenomena that occur in severe hyperthyroidism. But also, the fact that this phenomenon also occurs in hypothyroidism suggests that autoimmune mechanisms are possibly involved.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As for the reversibility of PHT once the thyroid cause is treated, it is still unclear. The problem is the significant limitation that exists in connection with the small number of patients in the studies conducted, the different treatments applied and PHT duration. Although, in most cases, the treatment of thyroid dysfunction improves or reverses PHT.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion, this case reflects the reported association between hyperthyroidism and severe PHT with complete resolution of the same after control of hyperthyroidism and emphasizes the need to investigate thyroid function in patients with PHT of known cause.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Varas I, de Miguel P, Molino ÁM. Hipertensión pulmonar grave secundaria a hipertiroidismo. Med Clin (Barc). 2016;147:e57–e58.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial hypertension: baseline characteristics from the REVEAL Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.B. Badesch" 1 => "G.E. Raskob" 2 => "C.G. Elliott" 3 => "A.M. Krichman" 4 => "H.W. Farber" 5 => "A.E. Frost" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-1140" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "376" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19837821" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary hypertension and thyroid disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Li" 1 => "R.E. Stafford" 2 => "J.F. Aduen" 3 => "M.G. Heckman" 4 => "J.E. Crook" 5 => "C.D. Burger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-0366" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "793" "paginaFinal" => "797" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17646226" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperthyroidism and pulmonary hypertension: an important association" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Vallabhajosula" 1 => "S. Radhi" 2 => "C. Cevik" 3 => "R. Alalawi" 4 => "R. Raj" 5 => "K. Nugent" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2011" "volumen" => "346" "paginaInicial" => "507" "paginaFinal" => "512" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoimmunity and pulmonary hypertension in patients with Graves’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Sugira" 1 => "S. Yamanaka" 2 => "H. Tekeuchi" 3 => "N. Morimoto" 4 => "M. Kamioka" 5 => "Y. Matsumura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00380-014-0518-3" "Revista" => array:6 [ "tituloSerie" => "Heart Vessels" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "642" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24838983" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014700000010/v1_201701210037/S2387020616307185/v1_201701210037/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014700000010/v1_201701210037/S2387020616307185/v1_201701210037/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616307185?idApp=UINPBA00004N" ]
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Letter to the Editor
Severe pulmonary hypertension secondary to hyperthyroidism
Hipertensión pulmonar grave secundaria a hipertiroidismo