Reversible pulmonary hypertension in Graves' disease

BACKGROUND: An association between pulmonary hypertension and hyperthyroidi sm has been described. An autoimmune mechanism is usually advocated but a d irect effect thyroid hormones on the pulmonary vascular system is also sugg ested. CASE REPORT: A 49-year-old woman with a history of Craves' disease was admi tted for sudden dyspnea. There was no evidence of ischemic stroke and the e lectrocardiogram and cardiac enzymes were normal. The lung scintiscan did n ot show any sign of pulmonary embolism. The chest computed tomography was n ormal. Doppler echocardiography found pulmonary hypertension with systolic pulmonary artery pressure of 68.7 mmHg. Thyroid function tests showed hyper thyroidism with recurrent Craves' disease. Pulmonary hypertension markedly decreased after the euthyroid state was achieved with antithyroid therapy. DISCUSSION: This patient had pulmonary hypertension associated with hyperth yroidism due to Craves' disease. The rapid reversibility of pulmonary hyper tension in this case after the achievement of the euthyroid slate suggest a pathogenic link between these two disorders and a possible direct effect o f thyroid hormones on the pulmonary vascular system.