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High Prevalence of Autoimmune Thyroid Disease in Pulmonary Arterial Hypertension^*

^* From the Divisions of Endocrinology and Metabolism (Dr. Chu) and Pulmonary and Critical Care Medicine (Drs. Kao, Faul, and Doyle), Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Correspondence to: Ramona L. Doyle, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Room H3147, Stanford University Medical Center, Stanford, CA 94305-5236; e-mail: rldoyle{at}stanford.edu

Study objectives: An association between thyroid disease and pulmonary arterial hypertension (PAH) has been reported, yet the pathogenetic relationship between these conditions remains unclear. Because immune system dysfunction may underlie this association, we sought to determine the prevalence of autoimmune thyroid disease (AITD) in patients with PAH.

Design and setting: Prospective observational study at a single academic institution.

Patients: Sixty-three consecutive adults with PAH (ie, sustained pulmonary artery systolic pressure, > 25 mm Hg) were evaluated for clinical, biochemical, and serologic features of AITD.

Measurements: Thyroid gland dysfunction was determined by clinical examination for goiter, and by biochemical measurements of thyrotropin and free thyroxine. Immune system dysfunction was determined by serologic measurements of antibodies to thyroglobulin and thyroid peroxidase. First-degree family history of AITD also was ascertained in order to investigate for genetic clustering of autoimmunity.

Results: Thirty-one patients (49%; 95% confidence interval [CI], 37 to 62%) received diagnoses of AITD. Eighteen patients were newly diagnosed, and 9 patients required the initiation of pharmacologic treatment. There was no chronologic relationship between the diagnosis or treatment of PAH and that of AITD. Sixteen patients (25%; 95% CI, 15 to 36%) had 24 first-degree family members with AITD.

Conclusions: Approximately half of the patients with PAH have concomitant AITD. These two conditions may be linked by a common immunogenetic susceptibility, and the elucidation of this association may advance the understanding of the pathophysiology and treatment of PAH. Systematic surveillance for occult thyroid dysfunction in patients with PAH may prevent the hemodynamic exacerbation of right heart failure.

Key Words: autoimmune thyroiditis • Graves disease • pulmonary hypertension • thyroid diseases

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