The paper itself includes this howler:
Thyroid disease is relatively common, remediable and easily studied.
I think we can probably agree to disagree with the paper on that point!
The fixation on TSH is also an issue. Surely we could hope for them to test FT4 and FT3? I mean, the number of studies which hint at something, but are undermined by being TSH-only, is huge. Does no-one ever learn that the initial cost savings of making it TSH-only are illusory? They miss important factors and end up having to re-do everything - if they can get funding and remain interested.
It's also rather depressing it is mortality that is associated with high TSH.
Pulmonary vasculature
Thyroid-stimulating hormone and mortality in pulmonary arterial hypertension
1. Hongyang Pi1,
2. Samuel G Rayner1,
3. David D Ralph1,
4. Stephanie Nolley1,
5. Lia M Barros1,
6. Zachary L Steinberg2 and
7. Peter J Leary1,3
Abstract
Introduction Pulmonary arterial hypertension (PAH) remains a serious and life-threatening illness. Thyroid dysfunction is relatively understudied in individuals with PAH but is known to affect cardiac function and vascular tone in other diseases. The aim of this observational study was to evaluate the association between thyroid-stimulating hormone (TSH), mortal and non-mortal outcomes in individuals with PAH.
Methods The Seattle Right Ventricle Translational Science (Servetus) Study is an observational cohort that enrolled participants with PAH between 2014 and 2016 and then followed them for 3 years. TSH was measured irrespective of a clinical suspicion of thyroid disease for all participants in the cohort. Linear regression was used to estimate the relationships between TSH and right ventricular basal diameter, tricuspid annular plane systolic excursion and 6-minute walk distance. Logistic regression was used to estimate the relationship with New York Heart Association Functional Class, and Cox proportional hazards were used to estimate the relationship with mortality. Staged models included unadjusted models and models accounting for age, sex at birth and aetiology of pulmonary hypertension with or without further adjustment for N-terminal-pro hormone brain natriuretic peptide.
Results Among 112 participants with PAH, TSH was strongly associated with mortality irrespective of adjustment. There was no clear consistent association between TSH and other markers of severity in a cohort with PAH.
Discussion This report reinforces the important observation that TSH is associated with survival in patients with PAH, and future study of thyroid dysfunction as a potential remediable contributor to mortality in PAH is warranted.
PiH, RaynerSG, RalphDD, et al
Thyroid-stimulating hormone and mortality in pulmonary arterial hypertension
BMJ Open Respiratory Research 2022;9:e001348. doi:10.1136/bmjresp-2022-001348
Abstract (above) and full PDF freely accessible here: