ANALYSIS OF PATIENTS FOR PULMONARY HYPERTENSION USING 2D ECHO IN THYROID DISORDER: A TEACHING HOSPITAL BASED OBSERVATIONAL STUDY.

Abstract

Background: It can be primary or secondary. In contrast to primary Pulmonary Arterial Hypertension (PAH) which is a diagnosis of exclusion, secondary PAH is caused by various conditions most common being cardiac diseases, respiratory diseases or both co-existing. Thyroid dysfunction is known to cause Pulmonary Hypertension (PH) which is also known to be reversible by restoration of euthyroid state. Hence, timely diagnosis and institution of medications can prevent as well as treat the secondary PAH in these patients.
Aims and Objectives: To Analyze the patients for presence of Pulmonary Hypertension using 2D ECHO in thyroid disorder.
Materials and Methods: It was an observational prospective study which included 52 newly diagnosed patients with thyroid dysfunction. All were subjected to 2D echocardiography with detailed history and physical examination. Repeat echocardiographic assessment was done after 6 months of treatment for few patients to look for resolution of Pulmonary Hypertension (PH). The
statistical analysis was carried out to determine the association of Pulmonary Hypertension with thyroid dysfunction using student’s t-test and chi-square test of association.
Results and Observations: The study included 38 (74%) females and 14 (26%) males. PH was present in 11 (22%) patients. Repeat echocardiography after 10 months of treatment (Eltroxin 1.6 microgram/kg for hypothyroid patients and Carbimazole (5/10 mg BD/TDS for hyperthyroid) was performed (those who were diagnosed with Pulmonary Hypertension at the time of diagnosis of
thyroid dysfunction) and reduction in Pulmonary Artery Systolic Pressure (PASP) was observed.
Conclusion: Significant percentage of patients with hypothyroidism developed various cardiovascular morbidities like DCM and pericardial effusion, moreover the level of T4 below a lower threshold level in hypothyroidism does not influence the severity of DCM or pericardial effusion or chamber size. High prevalence of Pulmonary Hypertension was observed in patients with thyroid dysfunctions at the time of diagnosis in the treatment naïve patients in the current study and it also reversed with treatment on repeat 2D-echo. It is, therefore, suggested that every patient of thyroid dysfunction should be screened for Pulmonary Hypertension, even though further studies are needed to substantiate this, due to an inherent small sample size of the study.