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Insights from Recognition of a Contradiction in the Equations that Define the Diffusing Capacity of the Lung for Carbon Monoxide. Ann Am Thorac Soc 2017; 14:473-474. [DOI: 10.1513/annalsats.201611-920le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dempsey JA, Olson EB, Skatrud JB. Hormones and Neurochemicals in the Regulation of Breathing. Compr Physiol 2011. [DOI: 10.1002/cphy.cp030207] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gültekin A, Yüksel M, Mert S, Berkarda S. Evaluation of alveolo-capillary permeability in thyrotoxicosis using Tc-99m DTPA aerosol scintigraphy. Ann Nucl Med 2005; 19:193-6. [PMID: 15981671 DOI: 10.1007/bf02984604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surfactant secreted from type II pneumocytes plays an important role in alveolo-capillary permeability. In thyrotoxicosis, high levels of T3 receptors detected at these cells might affect the alveolo-capillary permeability due to increased serum thyroid hormone levels. The results by CO-diffusion capacity measurement in thyrotoxicosis are conflicting. Changes in alveolo-capillary membrane permeability resulting from thyrotoxicosis are not well established yet. This prompted us to investigate the alveolo-capillary permeability in thyrotoxic patients in comparison with CO-diffusing capacity. For this aim twenty-two non-smoking thyrotoxic patients (before treatment) and fifteen healthy voluntary controls underwent 99mTc-DTPA aerosol scintigraphy. CO-diffusing and pulmonary function tests were performed in all subjects. After ventilation of radiotracer through a nebulizer for 15 minutes, 30 dynamic images (1 frame/minute) were taken from both lungs. ROI's were drawn over both lung areas, and the time-activity curves were generated. Then clearance half time (CT1/2) for radioaerosol was obtained. CT1/2 of thyrotoxic patients did not differ from that of the controls: 77.9 +/- 25.9 min vs. 79.4 +/- 22.3 min; p > 0.05. Similar result was found for CO-diffusion parameters. Also there was no significant correlation between CT1/2 and CO-diffusion parameters. We concluded that in patients with thyrotoxicosis, the alveolo-capillary permeability is unaffected. Further experimental research is needed to establish the possible effects of thyroid hormones on alveolo-capillary membrane.
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Affiliation(s)
- Aziz Gültekin
- Department of Nuclear Medicine, Trakya University Medical Faculty, Edirne, Turkey
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Soroush-Yari A, Burstein S, Hoo GWS, Santiago SM. Pulmonary hypertension in men with thyrotoxicosis. Respiration 2005; 72:90-4. [PMID: 15753642 DOI: 10.1159/000083408] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Accepted: 11/05/2003] [Indexed: 11/19/2022] Open
Abstract
Thyrotoxicosis has a myriad of respiratory symptoms including dyspnea. Pulmonary hypertension may contribute to the respiratory symptoms of thyrotoxicosis, but is often unrecognized. We describe 3 male patients with thyrotoxicosis and associated pulmonary hypertension. Case reports of an additional 15 patients are also reviewed. In patients with thyrotoxicosis and pulmonary hypertension, treatment of thyrotoxicosis alone is associated with improvement in pulmonary hypertension. Previous reports have consisted of mostly female patients, but we report 3 men. When all cases are considered, the typical patient is female (10/14 = 71%), middle-aged (48 years), with mean pulmonary artery systolic pressures improving from 56 to 32 mm Hg with treatment. Autoantibodies were detected in 10/14 (71%) patients. The response to treatment (medical or surgical) of thyrotoxicosis supports the hypothesis that hyperthyroidism is either a cause of pulmonary hypertension, or a factor that may unmask pulmonary hypertension. Recognition is important since treatment and response are very different compared to other patients with pulmonary hypertension. This association may not be readily considered in men, since most reports have been of women.
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Affiliation(s)
- Ardeshir Soroush-Yari
- Pulmonary and Critical Care Section, Department of Medicine, VA Greater Los Angeles Healthcare System, UCLA School of Medicine, Los Angeles, Calif., USA
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Presson RG, Baumgartner WA, Peterson AJ, Glenny RW, Wagner WW. Pulmonary capillaries are recruited during pulsatile flow. J Appl Physiol (1985) 2002; 92:1183-90. [PMID: 11842057 DOI: 10.1152/japplphysiol.00845.2001] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Capillaries recruit when pulmonary arterial pressure rises. The duration of increased pressure imposed in such experiments is usually on the order of minutes, although recent work shows that the recruitment response can occur in <4 s. In the present study, we investigate whether the brief pressure rise during cardiac systole can also cause recruitment and whether the recruitment is maintained during diastole. To study these basic aspects of pulmonary capillary hemodynamics, isolated dog lungs were pump perfused alternately by steady flow and pulsatile flow with the mean arterial and left atrial pressures held constant. Several direct measurements of capillary recruitment were made with videomicroscopy. The total number and total length of perfused capillaries increased significantly during pulsatile flow by 94 and 105%, respectively. Of the newly recruited capillaries, 92% were perfused by red blood cells throughout the pulsatile cycle. These data provide the first direct account of how the pulmonary capillaries respond to pulsatile flow by showing that capillaries are recruited during the systolic pulse and that, once open, the capillaries remain open throughout the pulsatile cycle.
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Affiliation(s)
- Robert G Presson
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, Indiana 46202-5200, USA.
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Abstract
Two patients presented with new onset of thyrotoxicosis and they then developed episodic wheezing a few months afterward. The asthmatic attacks improved when the patients were rendered in a euthyroid state with treatment. The present paper discusses the relationship between two diseases, hyperthyroidism and asthma, and the underlying factors potentially contributing to their conditions. The present findings suggest that asthma may develop in a susceptible individual with hyperthyroidism and it is possible that the reactive oxygen species may be a contributory factor in exacerbating wheezing in our hyperthyroid patients.
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Affiliation(s)
- K V Luong
- Vietnamese American Medical Research Foundation, Westminster, California, USA
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Nakchbandi IA, Wirth JA, Inzucchi SE. Pulmonary hypertension caused by Graves' thyrotoxicosis: normal pulmonary hemodynamics restored by (131)I treatment. Chest 1999; 116:1483-5. [PMID: 10559121 DOI: 10.1378/chest.116.5.1483] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We describe a case of pulmonary hypertension, initially thought to be idiopathic, which resolved after treatment of Graves' hyperthyroidism. Results of pulmonary artery catheterization before and after treatment are reported, and the effects of thyrotoxicosis on hemodynamics and pulmonary function are briefly reviewed. Possible mechanisms for development of pulmonary hypertension caused by hyperthyroidism include pulmonary vascular endothelial dysfunction or damage because of autoimmunity or the high cardiac output state, or increased metabolism of intrinsic pulmonary vasodilators.
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Affiliation(s)
- I A Nakchbandi
- Department of Medicine/Endocrinology, Yale University School of Medicine, New Haven, CT 06520-8020, USA.
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Nieswandt J, Wagner S, Schlegel J, Mohr-Kahaly S, Kahaly G. [Cardiopulmonary parameters in hyperthyroidism]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1999; 94:9-14. [PMID: 10081285 DOI: 10.1007/bf03044690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyperthyroid patients often suffer from impaired exercise capacity with dyspnoea. Two well established, non-invasive methods were used to evaluate the influence of hyperthyroidism on cardiopulmonary function. PATIENTS AND METHODS In 42 patients with hyperthyroidism we performed spirometry and cardiopulmonary exercise testing before and after 7 days of propranolol therapy as well as in euthyroidism. RESULTS In hyperthyroidism reduced vital capacity and 1-second capacity were observed (95.5 +/- 2.4% vs 102.6 +/- 1.5%; p = 0.0087; 89.4 +/- 2.3% vs 95.2 +/- 2.2%; p = 0.0179). No changes showed during beta-blockade. At the anaerobic threshold reduced tidal volume and enhanced respiratory frequency were noted (1119.8 +/- 48.9 ml vs 1289.3 +/- 62.7 ml; p = 0.0227; 28.3 +/- 0.8 vs 25.4 +/- 0.9; p = 0.0012). A significant tachycardia could be shown. Impaired response to exercise in pulse and respiratory frequency were observed. Work at the anaerobic threshold was impaired in hyperthyroidism (70 +/- 5 watts vs 86.9 +/- 5.7 watts; p = 0.016) and did not change during propranolol therapy. Oxygen pulse at the anaeorbic threshold was reduced in hyperthyroidism (7.7 +/- 0.4 ml O2/beat vs 9.1 +/- 0.4 ml O2/beat; p = 0.0012) and increased with propranolol (8.9 +/- 0.4 ml O2/beat; p = 0.0001). CONCLUSION In hyperthyroidism significant changes in cardiopulmonary function were noted at rest and exercise. High resting function and impaired response to exercise suggest a cardiopulmonary work with low efficiency. Propranolol leads to economization and lowers patients complaints.
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Affiliation(s)
- J Nieswandt
- Klinik und Poliklinik für Innere Medizin, Schwerpunkt Endokrinologie und Stoffwechselerkrankungen, Johannes-Gutenberg-Universität Mainz
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BURGESS JH, BISHOP JM. Pulmonary diffusing capacity and its subdivisions in polycythemia vera. J Clin Invest 1998; 42:997-1006. [PMID: 14016987 PMCID: PMC289367 DOI: 10.1172/jci104804] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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JOHNSON RL, TAYLOR HF, DEGRAFF AC. FUNCTIONAL SIGNIFICANCE OF A LOW PULMONARY DIFFUSING CAPACITY FOR CARBON MONOXIDE. J Clin Invest 1996; 44:789-800. [PMID: 14276136 PMCID: PMC292555 DOI: 10.1172/jci105191] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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MCCREDIE RM. THE DIFFUSING CHARACTERISTICS AND PRESSURE-VOLUME RELATIONSHIPS OF THE PULMONARY CAPILLARY BED IN MITRAL VALVE DISEASE. J Clin Invest 1996; 43:2279-89. [PMID: 14234824 PMCID: PMC289656 DOI: 10.1172/jci105102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kahaly G, Hellermann J, Mohr-Kahaly S, Treese N. Impaired cardiopulmonary exercise capacity in patients with hyperthyroidism. Chest 1996; 109:57-61. [PMID: 8549218 DOI: 10.1378/chest.109.1.57] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE Hyperthyroidism (H) has been implicated as a primary cause of decreased exercise tolerance. To our knowledge, analysis of respiratory gas exchange, an efficient noninvasive method in evaluating cardiopulmonary capacity, has not been performed in patients with H. PATIENTS Using cardiopulmonary exercise testing, 12 consecutive women with Graves' H were examined and controlled in euthyroidism (E). Eighteen women with E, in whom cardiac catheterization had ruled out heart disease, served as control subjects (C). MEASUREMENTS The ventilatory anaerobic threshold was determined by means of the V-slope method. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol of 20 W/min. Echocardiography at rest was performed in all patients. RESULTS In patients with H, heart rate at rest was higher than in patients with E (p < 0.05) and showed a markedly lower increase between rest and anaerobic threshold compared with E patients (p = 0.007) and C (p = 0.009). Work rate was reduced (H, 50% vs E, 70%; p = 0.038). In H patients, the anaerobic threshold occurred at 59.6% of maximal oxygen uptake and 72% in E patients, respectively (p = 0.024). In H patients, the linear regression of the heart rate to oxygen uptake ratio showed a reduced slope in comparison with E patients (p = 0.001) and C (p = 0.004). In patients with H, a reduced tidal volume (p = 0.021) and an increased respiratory rate (p = 0.003) in comparison to patients with E were demonstrated. Echocardiographically, H patients had an increased ejection fraction (p = 0.008) and a higher cardiac index (p = 0.008) in comparison with E patients. CONCLUSIONS Analysis of respiratory gas exchange showed marked alterations of cardiopulmonary exercise capacity in H patients, which are reversible in E patients. The impaired chronotropic response during exercise might be the primary limiting factor of reduced work capacity in patients with H.
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Affiliation(s)
- G Kahaly
- Department of Medicine III (Endocrinology/Metabolism), Johannes-Gutenberg-University Hospital, Mainz, Germany
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Otsuka H, Murata M, Wakasugi K, Hara M, Iketani Y, Tatara K. Exercise performance in children with hyperthyroidism. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1994; 36:678-82. [PMID: 7871982 DOI: 10.1111/j.1442-200x.1994.tb03269.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An attempt was made to define exercise performance in children with untreated hyperthyroidism using treadmill stress testing. Data were obtained for five female patients and the results were compared with those obtained for 16 normal female subjects. There were no significant differences at rest between the hyperthyroidism group and the control group in oxygen uptake, minute ventilation and respiratory rate. On the other hand, heart rate in the hyperthyroidism group was significantly higher than that in the control group. During exercise, there were significant differences between the two groups in oxygen uptake, heart rate, minute ventilation and respiratory rate. Hyperthyroid patients did not show an abrupt increase in heart rate during the first 30 s of exercise. Exercise stress testing can therefore reveal cardiopulmonary abnormalities that are not evident at rest in children with hyperthyroidism.
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Affiliation(s)
- H Otsuka
- Department of Pediatrics, Tokyo Women's Medical College, Daini Hospital, Japan
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Orme SM, Sebastian JP, Page MD, Cowan C, Belchetz PE. Thyrotoxicosis increases right to left shunt in congenital cyanotic heart disease. Clin Endocrinol (Oxf) 1993; 39:253-6. [PMID: 8370139 DOI: 10.1111/j.1365-2265.1993.tb01783.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We wish to report two cases of congenital cyanotic heart disease in whom coexisting thyrotoxicosis increased the right to left shunt. We review the literature on the cardiac and respiratory effects of thyroid hormone to try to explain this phenomenon. Two patients, one with Fallot's tetralogy (diagnosed at 68 years of age), the other with a ventricular septal defect, developed thyrotoxicosis which resulted in a dramatic but reversible deterioration in their cardiac condition. We conclude that thyrotoxicosis increases right to left shunt in congenital cyanotic heart disease. This effect is profound but reversible. We suggest that when an unexplained rapid deterioration occurs in patients with congenital cyanotic heart disease, thyrotoxicosis should be excluded.
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Affiliation(s)
- S M Orme
- Department of Endocrinology, General Infirmary at Leeds, UK
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16
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Abstract
The aim of this review was to demonstrate that RM function is altered in various endocrinopathies and that RM weakness is a common finding. RM function has been well-studied in diseases such as thyroid dysfunction, and steroid induced RM myopathies. Less well documented reports on RM function were found in parathyroid dysfunctions, disorders of mineralocorticoids and pituitary disturbances. Controversial reports were found in diabetes mellitus. No report was found connecting RM function with androgens, pheochromocytoma or adrenaline deficiency in humans. These diseases could potentially cause RM impairment leading to severe respiratory failure (pump failure) putting life in great danger. Therefore, it is obvious that further studies are needed to investigate the performance of RMs in endocrinopathies. Such studies are extremely urgent in Cushing's and Addison's disease, acromegaly, disorders of the adrenal medulla, and in diabetes insipidus.
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Affiliation(s)
- N M Siafakas
- Department of Thoracic Medicine, University Hospital of Heraklion, University of Crete, Medical School, Greece
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17
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Nabishah BM, Morat PB, Alias AK, Kadir BA, Khalid BA. Cyclic adenosine 3',5'-monophosphate content and bronchial smooth muscle contractility of hyper- and hypothyroid lungs. Clin Exp Pharmacol Physiol 1992; 19:839-42. [PMID: 1335381 DOI: 10.1111/j.1440-1681.1992.tb00423.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
1. Male Sprague-Dawley rats were made either hyper- or hypothyroid with thyroxine or 4-methyl-2-thiouracil, respectively. Bronchial smooth muscle (BSM) contractility and lung cyclic adenosine 3',5'-monophosphate (cAMP) content were measured in both conditions. 2. Bronchial smooth muscle contractility was significantly weaker in hyperthyroid rats, while the BSM contractility of hypothyroid rats was the same as controls. 3. The cAMP content of hyperthyroid rat lungs was similar to controls but was decreased in hypothyroid rats. 4. These studies demonstrated that both the hyper- and hypothyroid states affect respiration, although the mechanisms involved with different for each condition.
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Affiliation(s)
- B M Nabishah
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur
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Small D, Gibbons W, Levy RD, de Lucas P, Gregory W, Cosio MG. Exertional dyspnea and ventilation in hyperthyroidism. Chest 1992; 101:1268-73. [PMID: 1582283 DOI: 10.1378/chest.101.5.1268] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Dyspnea is recognized to be an important feature in patients with hyperthyroidism at rest and during exercise. However, its etiology is not well-understood. Since dyspnea is thought to be related to the perception of excessive ventilatory effort, we explored the possibility that dyspnea in these patients might be related to an inappropriate ventilatory response to the increased metabolic rate. We studied 11 hyperthyroid patients and 11 age- and sex-matched controls, performing spirometry, lung volumes, mouth pressure measurements, and incremental exercise test. Central drive was estimated by measuring P0.1 and sensation of dyspnea by the Borg scale. We found that hyperthyroid patients (1) have higher ventilation than normal subjects during exercise even when corrected for VCO2 levels; (2) this increased ventilation is secondary to increased central drive which is correlated to the T3ria level (r = 0.85, p less than 0.01); (3) hyperthyroid patients are more dyspneic than controls; and (4) the increased drive can be normalized by beta-blockade. We conclude that the main ventilatory abnormality in hyperthyroid patients is an inappropriate increase in respiratory drive, possibly secondary to increased adrenergic stimulation.
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Affiliation(s)
- D Small
- Desmond N. Stoker Pulmonary Laboratory, Royal Victoria Hospital, McGill University, Montreal (Quebec), Canada
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Behera D, Roy R, Dash RJ, Jindal SK. Airway response to inhaled fenoterol in hyperthyroid patients before and after treatment. J Asthma 1992; 29:369-74. [PMID: 1429390 DOI: 10.3109/02770909209044800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bronchodilatory response to inhaled fenoterol was studied in 15 hyperthyroid patients before and after successful treatment with antithyroid drugs. Baseline forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were lower than the predicted values in 12 and 11 patients, respectively. Improved values were seen after treatment for hyperthyroidism although statistical significance was not reached. Even if some improvement occurred in PEFR (a rise by 0.24-0.48 L/s) and FVC (increase of 73-78 ml) in the hyperthyroid state in response to fenoterol inhalation after various time intervals, the increase in different parameters of lung function was significantly more after the patients achieved euthyroid state (increases in FVC by 290-165 ml; in FEV1 by 333-193 ml; in peak expiratory flow (PEFR) by 0.75-0.52 L/s and in forced expiratory flow (FEF50%) by 0.55-0.31 L/s). In the euthyroid state the mean absolute improvements from the baseline values were significantly higher (< 0.05-0.001). These observations indicate that bronchodilatory response is impaired in the presence of excess thyroid hormones and improves after euthyroid state is achieved.
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Affiliation(s)
- D Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Brüssel T, Matthay MA, Chernow B. Pulmonary Manifestations of Endocrine and Metabolic Disorders. Clin Chest Med 1989. [DOI: 10.1016/s0272-5231(21)00658-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lipworth BJ, Dhillon DP, Clark RA, Newton RW. Problems with asthma following treatment of thyrotoxicosis. BRITISH JOURNAL OF DISEASES OF THE CHEST 1988; 82:310-4. [PMID: 3248214 DOI: 10.1016/0007-0971(88)90075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe two cases of asthma associated with concomitant thyrotoxicosis where initial improvement followed antithyroid treatment. Relapse of asthma on thyroxine replacement was accompanied by subclinical hyperthyroidism with elevated levels of triiodothyronine. This emphasizes the need to follow up asthmatic patients closely for biochemical relapse following treatment of thyrotoxicosis.
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Affiliation(s)
- B J Lipworth
- Department of Thoracic Medicine, King's Cross Hospital, Dundee
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22
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Wang YT, Poh SC. Lung function and respiratory muscle strength after propranolol in thyrotoxicosis. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1986; 16:496-500. [PMID: 2432869 DOI: 10.1111/j.1445-5994.1986.tb02020.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thirty-five thyrotoxic patients were assessed before treatment, after treatment with propranolol, and after antithyroid drugs. The first group of patients (n = 17) performed the following tests at all three assessment points: forced expiratory volume in the first second (FEV1), vital capacity (VC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), maximal mid-expiratory flow rate (MMFR), diffusing capacity for carbon monoxide (DLCO), and maximum static inspiratory and expiratory mouth pressures (PImax and PEmax). Arterial blood gas analysis was also performed for the first group of patients. No significant changes were seen either after propranolol or after antithyroid drugs in the FRC, RV, TLC, MMFR, DLCO, or blood gases. The remaining 18 patients, group 2, performed only the FEV1, VC, PImax, and PEmax tests at each assessment. The only index of respiratory function that improved significantly after propranolol was PImax (from 46.5 +/- 16.5 to 53.2 +/- 22 cmH2O, p less than 0.01). This suggests that adrenergic excess may play a role in thyrotoxic inspiratory muscle weakness. After antithyroid drugs, PImax, PEmax, FEV1, and VC all increased significantly as expected.
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24
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Harrison RN, Tattersfield AE. Airway response to inhaled salbutamol in hyperthyroid and hypothyroid patients before and after treatment. Thorax 1984; 39:34-9. [PMID: 6695351 PMCID: PMC459718 DOI: 10.1136/thx.39.1.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
For many years the development of thyrotoxicosis has been known to cause a deterioration in asthma but the mechanism is unknown. We have studied the effect of thyroid function on airway beta adrenergic responsiveness in 10 hyperthyroid and six hypothyroid subjects before and after treatment of their thyroid disease. Airway adrenergic responsiveness was assessed by measuring specific airway conductance (sGaw) after increasing doses of inhaled salbutamol (10-410 micrograms). After treatment there was no difference in resting FEV1, sGaw, or thoracic gas volume. FVC increased in the hyperthyroid subjects but did not change in the hypothyroid subjects. In the hyperthyroid subjects there was a significant increase in delta sGaw after 35, 60, 110, and 41 micrograms salbutamol; in sGaw after 60, 110, and 410 micrograms salbutamol; and in the area under the salbutamol dose response curve (AUC) after treatment of the thyroid disorder. In the hypothyroid subjects there was a significant reduction in sGaw after 10 and 60 micrograms salbutamol and in the AUC after treatment. When all subjects were considered, there was a negative correlation between the AUC and serum thyroxine values. These findings suggest that an inverse relationship exists between the level of thyroid function and airway beta adrenergic responsiveness.
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Abstract
Shortness of breath is a common symptom in thyrotoxicosis and it may have a number of causes. We have studied dyspnoea, skeletal muscle power and respiratory muscle power in eleven patients who had thyrotoxicosis with no evidence of heart failure. Four patients (36.4%) had a marked improvement with treatment in the maximal inspiratory pressure developed at the mouth. All four were breathless and had a proximal myopathy before treatment. This confirms the existence of a group of thyrotoxic patients with a reversible respiratory muscle myopathy which may explain the frequent finding of breathlessness on exertion in such patients.
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Abstract
Ten patients with severe dyspnoea and chronic airflow obstruction entered a randomised double-blind crossover trial comparing the effect of carbimazole 80 mg daily for two months with that of placebo. Assessment of thyroid function, lung function, and exercise tolerance was performed monthly. The mean free thyroxine index after two months of carbimazole was significantly lower at 64.1 (+/- 10.5, SEM) than the 89.1 (+/- 3.8) while on placebo. Serum tri-iodothyronine was reduced and thyroid stimulating hormone raised while on the active drug. There was no significant difference in the 12-minute walking distance (TMD), the rating of perceived exertion during the TMD, the oxygen cost score, the dyspnoea grade, the resting arterialised capillary blood gas tensions or the resting minute ventilation. During a progressive exercise test to exhaustion on a cycle ergometer, there was no significant difference in the minute ventilation, heart rate, blood gas tensions at exhaustion, or the total work done. There were no symptoms or signs of hypothyroidism. Lung function (FEV1, FVC, TLC, KCO) was unchanged. Thus a 28% reduction in the free thyroxine index produced no symptomatic or objective benefit in exercise tolerance in patients with severe airflow obstruction. These results provide no support for the use of carbimazole in chronic airflow obstruction.
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Freedman S. Lung volumes and distensibility, and maximum respiratory pressures in thyroid disease before and after treatment. Thorax 1978; 33:785-90. [PMID: 746506 PMCID: PMC470980 DOI: 10.1136/thx.33.6.785] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung volumes, static pressure volume curves of the lung, and maximum respiratory pressures were measured in six patients with thyrotoxicosis and three with myxoedema before and after treatment. After treatment three of the thyrotoxic patients had increases in vital capacity of the same order as previously reported, but in contrast to previous reports, the lung volume changes were not associated with, nor due to, concomitant changes in respiratory muscle performance. Static pulmonary compliance increased in four of the six patients. The initial findings were more in keeping with the presence of pulmonary congestion. Only one of the myxoedematous patients had any significant increase in vital capacity after treatment, and in her case this was clearly attributable to increased inspiratory muscle force.
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Turino GM, Goldring RM. Techniques for measuring the responsiveness of the ventilatory apparatus in man in disease. Chest 1976; 70:180-5. [PMID: 939142 DOI: 10.1378/chest.70.1_supplement.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
More complete understanding of the disturbances in the regulation of ventilation in disease must await techniques which can estimate the neural output of the respiratory centers and also the neural inputs. Some of these techniques, such as diaphragmatic electromyography, offer the prospect of clinical usefulness even now and newer techniques, such as mouth occlusion pressure, are promising but have just begun to be evaluated in disease. Despite the limited ability of current techniques to clearly distinguish abnormal central nervous system function of ventilatory control from peripheral mechanical limitations to ventilation, a useful interpretation of clinical tests of ventilatory responsiveness may be gained by an awareness of the many physiologic and pathogenetic factors which are interposed by disease. These factors may reinforce or diminish both stimuli and response. In chronic disease states, these modifying factors must be identified and evaluated for their role in altered ventilatory responsiveness. Frequently, therapeutic measures can induce substantial effects on these modifying factors, whereas primary disturbances of central nervous system function may be difficult to alter. For the above reasons, tests of ventilatory responsiveness which provide information focussed only on the normality or abnormality of responsiveness to CO2 breathing from measurement of minute ventilation and alveolar PCO2 in an unsteady state, as in the CO2 rebreathing test, may, in a patient, require the addition of tests which allow more complete evaluation of these modifying factors. The state of arterial blood gases, hydrogen ion concentration, bicarbonate concentration, pulmonary function, ventilatory response to exercise, as well as understanding of the state of body temperature, catecholamine secretion, the functional state of the muscles of ventilation, as well as the resistances to ventilation are all a necessary part of the evaluation.
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Young RC, Fields HP, Scott JM, Carr C, Harden KA. Lung diffusing capacity response to exercise in sarcoidosis. A physiologic study. J Natl Med Assoc 1969; 61:508-13. [PMID: 5359201 PMCID: PMC2611808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kötter D, Huch A, Stotz H, Piiper J. Single breath CO diffusing capacity in anesthetized dogs with increased oxygen consumption. RESPIRATION PHYSIOLOGY 1969; 6:202-8. [PMID: 5773388 DOI: 10.1016/0034-5687(69)90058-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Massey DG, Becklake MR, McKenzie JM, Bates DV. Circulatory and ventilatory response to exercise in thyrotoxicosis. N Engl J Med 1967; 276:1104-12. [PMID: 6024164 DOI: 10.1056/nejm196705182762002] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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