Pediatric Pulmonary Arterial Hypertension and Hyperthyroidism: A Potentially Fatal Combination

• Published in: The journal of clinical endocrinology and metabolism Vol. 97; no. 7; pp. 2217 - 2222
• Main Authors: Trapp, Christine M, Elder, Robert W, Gerken, Adrienne T, Sopher, Aviva B, Lerner, Shulamit, Aranoff, Gaya S, Rosenzweig, Erika B
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.07.2012; Copyright by The Endocrine Society
• Series: Clinical Case Seminar
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Endocrinopathies; Familial Primary Pulmonary Hypertension; Fatal Outcome; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - therapy; Hyperthyroidism - complications; Hyperthyroidism - diagnosis; Hyperthyroidism - mortality; Hyperthyroidism - therapy; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Retrospective Studies; Thyroid. Thyroid axis (diseases); Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult; Endocrinopathy; Human; Obesity; Pediatrics; Nutrition; Respiratory disease; Hyperthyroidism; Thyroid diseases; Nutrition disorder; Cardiovascular disease; Metabolic diseases; Artery; Pulmonary hypertension; Blood vessel; Circulatory system; Child; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2012-1109

Context: Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death. Cases and Setting: We present a series of eight idiopathic PAH/heritable PAH pediatric patients who developed hyperthyroidism between 1999 and 2011. Institutional Review Board approval was obtained; informed consent was waived due to the retrospective nature of the series. All eight patients were receiving iv epoprostenol; five of the eight patients presented with acute cardiopulmonary decompensation in the setting of hyperthyroidism. In the remaining three patients, hyperthyroidism was detected during routine screening of thyroid function tests. The one patient who underwent emergency thyroidectomy was the only survivor of those who presented in cardiopulmonary decline. Evidence Synthesis: Aggressive treatment of the hyperthyroid state, including emergency total thyroidectomy and escalation of targeted PAH therapy and β-blockade when warranted, may prove lifesaving in these patients. Prompt thyroidectomy or radioactive iodine ablation should be considered for clinically stable PAH patients with early and/or mild hyperthyroidism to avoid potentially life-threatening cardiopulmonary decompensation. Conclusions: Although the association between hyperthyroidism and PAH remains poorly understood, the potential impact of hyperthyroidism on the cardiopulmonary status of PAH patients must not be ignored. Hyperthyroidism must be identified early in this patient population to optimize intervention before acute decompensation. Thyroid function tests should be checked routinely in patients with PAH, particularly those on iv epoprostenol, and urgently in patients with acute decompensation or symptoms of hyperthyroidism.