title: Pediatric pulmonary arterial hypertension and hyperthyroidism: a potentially fatal combination.
abstract: BACKGROUND
  Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death.
  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.
  
  
  RESULTS
  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.
authors.affiliation: Division of Pediatric Endocrinology, Children’s Hospital of New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Trapp
authors.forename: Robert W
authors.initials: RW
authors.lastname: Elder
authors.forename: Adrienne T
authors.initials: AT
authors.lastname: Gerken
authors.forename: Aviva B
authors.initials: AB
authors.lastname: Sopher
authors.forename: Shulamit
authors.initials: S
authors.lastname: Lerner
authors.forename: Gaya S
authors.initials: GS
authors.lastname: Aranoff
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rosenzweig
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D065627:Familial Primary Pulmonary Hypertension; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006980:Hyperthyroidism / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult