Thyroid-stimulating hormone and mortality in pulmonary arterial hypertension

[helvella]

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:

bmjopenrespres.bmj.com/cont...

[jimh111]

Strange that there was no endocrinologist on the team. Although it probably wouldn't have been much help!

There's a well known link between hypothyroidism and hypertension, presumably from increased vascular tension. Yet another case of medical science moving at glacial speed. Instead of just measuring TSH they could have measured all three hormones and most importantly done a double blind intervention trial.

This wasteful sloppy research drives me nuts. We often see silly meta-analyses that eliminate 99% of available studies because they fail to meet quality requirements. So, why do the sloppy studies in the first place?

[HowNowWhatNow in reply to jimh111]

A case of “this will look good on my CV” overshadowing benefit to civilisation. I’m sure that when VIPs - Presidents, Queens, Elon Musk’s ilk and Sheikhs - get ill, medics from the various specialisms work together and try to speak to each other in language they can agree on, without overly dumbing down. Outside of VIP-land, not so much.

Is the risk of hypertension raised when TSH is too high? And when TSH is too low / non-existent?

[jimh111 in reply to HowNowWhatNow]

I don’t know of actual studies looking at TSH and blood pressure but have seen reports of blood pressure coming down when hypothyroidism is treated. Certainly treating a high TSH will not resolve all cases of hypertension, there can be lots of causes including clogged blood vessels.

[jimh111 in reply to HowNowWhatNow]

You might find this interesting healthunlocked.com/thyroidu... . I will not have time to read the study.

[HowNowWhatNow in reply to jimh111]

Thank you

[helvella Administrator Thyroid UK]

Possibly also interesting to visit this post:

Role of thyroid hormone in an experimental model of atherosclerosis: the potential mediating role of immune response and autophagy

healthunlocked.com/thyroidu...

[HowNowWhatNow in reply to helvella]

Thank you