Tiroid Hastalıkları ve Akciğer
Özet
Tiroid hastalıkları, vücut metabolizmasını düzenleyen hormonların salgılanmasındaki bozukluklar ve embriyolojik olarak ortak köken paylaştıkları akciğer sistemi üzerinde önemli pulmoner patolojilere yol açabilmektedir. Hipotiroidizm durumunda solunum dürtüsünün azalması, solunum kaslarında güçsüzlük, vital kapasitede düşüş, obstrüktif uyku apnesi sendromu riskinde artış ve plevral efüzyon gibi ciddi tablolar gözlenmektedir. Hipertiroidizm ise hipermetabolik sürece bağlı olarak oksijen tüketimini ve karbondioksit üretimini artırarak hastada efor ve istirahat dispnesine (tirotoksik dispne) ve solunum kaslarında zayıflığa neden olur. Ayrıca hem hipotiroidi hem de hipertiroidi süreçlerinde vasküler mekanizmaların bozulmasıyla pulmoner hipertansiyon gelişebilmektedir. Büyük guatrlar veya retrosternal kitleler, trakeaya dıştan bası uygulayarak üst hava yolu obstrüksiyonu, öksürük ve stridor semptomları yaratırken; otoimmün tiroiditler akciğerde inflamasyonu ve bronş hiperreaktivitesini tetikleyebilmektedir. Son olarak nadir de olsa papiller, foliküler ve Hürthle hücreli tiroid kanserleri akciğere metastaz yapma eğilimi gösterebilir. Tüm bu patolojiler, tiroid ve akciğer fonksiyonlarının multidisipliner bir yaklaşımla ele alınması gerektiğini ortaya koymaktadır.
Thyroid disorders can lead to significant pulmonary pathologies due to hormone secretion imbalances and their shared embryological origin with the respiratory system. In hypothyroidism, patients experience a decreased respiratory drive, respiratory muscle weakness, reduced vital capacity, an increased risk of obstructive sleep apnea syndrome, and pleural effusion. Conversely, hyperthyroidism accelerates oxygen consumption and carbon dioxide production because of a hypermetabolic state, resulting in exertional or resting dyspnea (thyrotoxic dyspnea) along with respiratory muscle weakness. Furthermore, both hypothyroid and hyperthyroid states can induce pulmonary hypertension through vascular impairment and endothelial dysfunction. Large cervical or retrosternal goiters cause upper airway obstruction, cough, and stridor by exerting external pressure on the trachea, while autoimmune thyroiditis can exacerbate airway inflammation and bronchial hyperreactivity. Lastly, although rare, differentiated thyroid carcinomas such as papillary, follicular, and Hürthle cell cancers can metastasize to the lungs. These interconnected conditions demonstrate that thyroid and pulmonary complications must be evaluated through a comprehensive, multidisciplinary approach.
Referanslar
Boggaram V. Thyroid transcription factor-1 (TTF-1/Nkx2.1/TITF1) gene regulation in the lung. Clinical Science (London). 2009 Jan;116(1):27-35. doi: 10.1042/CS20080068.
Saaresranta T, Polo O. Hormones and breathing. Chest. 2002;122(6):2165–2182.
Krem CL, Aihua LI, Nattie EE. RTN TRH causes prolonged respiratory stimulation. Journal of Applied Physiology. 997;83(3):792–799.
Eman A. Assessment of functional lung impairment in patients with thyroid disorders. Egyptian Journal of Bronchology, 2016; 10:337–347.
Birring SS, Morgan AJ, Prudon B, et al. Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease. Thorax 2003; 58:533–536.
Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. New England Journal of Medicine. 1975 Mar 27;292(13):662-665. doi: 10.1056/NEJM197503272921302.
Datta D, Scalise P. Hypothyroidism and failure to wean in patients receiving prolonged mechanical ventilation at a regional weaning center. Chest. 2004 Oct;126(4):1307-1312. doi: 10.1378/chest.126.4.1307
Cakmak G, Saler T, Saglam ZA, et al. Pulmonary functions in patients with subclinical hypothyroidism. Journal Of Pakistan Medical Association 2011; 61(10):951-953.
Mohammed RN, Kadhum HJ, Hashim AR. Spirometry in adult hypothyroid patients: a comparative study. Journal of Basic Clinical Physiology and Pharmacology. 2020 Nov 13;32(3):189-195. doi: 10.1515/jbcpp-2019-0359.
Siafakas NM, Salesiotou V, Filaditaki V, et al. Respiratory muscle strength in hypothyroidism. Chest. 1992;102(1):189–194
Laroche CM, Cairns T, Moxham J, Green M. Hypothyroidism presenting with respiratory muscle weakness. American Review of Respiratory Disease. 1988;138(2):472–474.
Sadek SH, Khalifa WA, Azoz AM. Pulmonary consequences of hypothyroidism. Annals of Thoracic Medicine 2017;12(3):204-208. doi: 10.4103/atm.ATM_364_16.
Lankhaar JA, de Vries WR, Jansen JA, et al. Impact of overt and subclinical hypothyroidism on exercise tolerance: a systematic review. Research Quarterly for Exercise and Sport. 2014; 85(3):365-89. doi: 10.1080/02701367.2014.930405.
Khushu S, Rana P, Sekhri T, et al. Bio-energetic impairment in human calf muscle in thyroid disorders: a 31P MRS study. Magnetic Resonance Imaging. 2010 Jun;28(5):683-689. doi: 10.1016/j.mri.2010.01.006. Epub 2010 Mar 23.
Martinez FJ, Bermudez-Gomez M, Celli BR. Hypothyroidism: A reversible cause of diaphragmatic dysfunction. Chest. 1989;96(5):1059–1063.
Baldwin KM, Hooker AM, Herrick RE, Schrader LF. Respiratory capacity and glycogen depletion in thyroid-deficient muscle. Journal of applied physiology: respiratory, environmental and exercise physiology. 1980;49(1):102–106.
Kumar G, Kumar A, Bundela RP, et al. Hypothyroidism Presenting as Multiple Body Cavity Effusions. The Journal of the Association of Physicians of India. 2016 Jul;64(7):83-84.
Gottehrer A, Roa J, Stanford GG, et al. Hypothyroidism and pleural effusions. Chest. 1990 Nov; 98(5):1130-2. doi: 10.1378/chest.98.5.1130.
Parving HH, Hansen Jm, Nielsen Sl, et al. Mechanisim of edema formation in myxedema-increased protein extravasation and relative slow lymphatic drainage. New England Journal of Medicine 1979;301:460-465.
Kuczyński W, Gabryelska A, Mokros Ł, Białasiewicz P. Obstructive sleep apnea syndrome and hypothyroidism - merely concurrence or causal association? Pneumonologia i alergologia polska. 2016;84(5):302-306. doi: 10.5603/PiAP.2016.0038.
Skatrud J, Iber C, Ewart R, et al. Disordered breathing during sleep in hypothyroidism. American Review of Respiratory Disease. 1981 Sep;124(3):325-9. doi: 10.1164/ arrd.1981.124.3.325
Bruyneel M, Veltri F, Poppe K. Prevalence of newly established thyroid disorders in patients with moderate-to-severe obstructive sleep apnea syndrome. Sleep Breath 2019 Jun;23(2):567-573. doi: 10.1007/s11325-018-1746-z. Epub 2018 Oct 27.
BaHammam AS, Aleissi S, Olaish AH, et al. Prevalence of Hypothyroidism in a Large Sample of Patients with Obesity Hypoventilation Syndrome. Nature and science of sleep. 2020 Sep 16;12:649-659. doi: 10.2147/NSS.S263959.
Curnock AL, Dweik RA, Higgins BH, et al. High prevalence of hypothyroidism in patients with primary pulmonary hypertension. American Journal of Medical Science. 1999 Nov;318(5):289-92. doi: 10.1097/00000441-199911000-00001.
Vicinanza R, Coppotelli G, Malacrino C, et al. Oxidized low-density lipoproteins impair endothelial function by inhibiting non-genomic action of thyroid hormone-mediated nitric oxide production in human endothelial cells. Thyroid. 2013 Feb;23(2):231-8. doi: 10.1089/thy.2011.0524.
Scicchitano P, Dentamaro I, Tunzi F, et al. Pulmonary hypertension in thyroid diseases. Endocrine. 2016 Dec;54(3):578-587. doi: 10.1007/s12020-016-0923-8. Epub 2016 Mar 19.
Nicolls MR, Taraseviciene-Stewart L, Rai PR, et al. Autoimmunity and pulmonary hypertension: a perspective. The European respiratory journal 2005 Dec;26(6):1110-8. doi: 10.1183/09031936.05.00045705.
Fabro AT, Minatel IO, Rangel MP, et al. Usual interstitial pneumonia and smoking-related interstitial fibrosis display epithelial to mesenchymal transition in fibroblastic foci. Respiratory medicine 2014;108:1377-1386. 10.1016/j.rmed.2014.06.008
Wert SE, Dey CR, Blair PA, et al. Increased expression of thyroid transcription factor-1 (TTF-1) in respiratory epithelial cells inhibits alveolarization and causes pulmonary inflammation. Developmental biology 2002;242:75-87. 10.1006/dbio.2001.0540
Sato Y, Tanino Y, Nikaido T, et al. Clinical significance of thyroid hormone and antibodies in patients with idiopathic interstitial pneumonia. Journal of thoracic disease. 2020 Mar;12(3):522-537. doi: 10.21037/jtd.2020.01.02.
Fois AG, Paliogiannis P, Sotgia S, et al. Evaluation of oxidative stress biomarkers in idiopathic pulmonary fibrosis and therapeutic applications: a systematic review. Respiratory research 2018;19:51. 10.1186/s12931-018-0754-7
Mancini A, Di Segni C, Raimondo S, et al. Thyroid Hormones, Oxidative Stress, and Inflammation. Mediators of inflammation 2016;2016:6757154.
Perrotta C, Buldorini M, Assi E, et al. The thyroid hormone triiodothyronine controls macrophage maturation and functions: protective role during inflammation. American Journal of Pathology 2014;184:230-47. 10.1016/j.ajpath.2013.10.006
Alonso-Merino E, Martin Orozco R, Ruiz-Llorente L, et al. Thyroid hormones inhibit TGF-beta signaling and attenuate fibrotic responses. Proceedings of the National Academy of Sciences of the United States of America 2016;113:E3451-3460. 10.1073/pnas.1506113113
Brent GA. Clinical practice. Graves' disease. New England Journal of Medicine. 2008 Jun 12;358(24):2594-605. doi: 10.1056/NEJMcp0801880.
Kahaly G, Hellermann J, Mohr- Kahaly S, et al. Impaired cardiopulmonary exercise capacity in patients with hyperthyroidism. Chest 1996;109:57-61.
Pino-Garcia J.M, Garcia-Rio F, Diez J.J, et al. Regulation of breathing in hyperthyroidism: relationship to hormonal and metabolic changes The Europan Respiratory Journal, 1998 Aug;12(2):400-7. doi: 10.1183/09031936.98.12020400.
Small D, Gibbons W, Levy RD, et al. Exertional dyspnea and ventilation in hyperthyroidism. Chest 1992 May;101(5):1268-73. doi: 10.1378/chest.101.5.1268.
Siafakas-2 NM, Milona I, Salesiotou V, et al. Respiratory muscle strength in hyperthyroidism before and after treatment. American Review of Respiratory Disease 1992;146:1025-1029.
Otsuka H, Murata M, Wakasugi K, et al. Exercise performance in children with hyperthyroidism. Acta Paediatrica Japonica, 1994 Dec;36(6):678-682. doi: 10.1111/j.1442-200x.1994.tb03269.x.
Guleria R, Goswami R, Shah P, et al. Dyspnea, lung function & respiratory muscle pressures in patients with Graves' disease. The Indian journal of medical research. 1996;104:299-303.
Irace L, Pergola V, Di Salvo G, et al. Work capacity and oxygen uptake abnormalities in hyperthyroidism. Minerva Cardioangiology. 2006 Jun;54(3):355-62. PMID: 16733509.
Nabishah BM, Morat PB, Alias AK, et al. Cyclic adenosine 3',5'-monophosphate content and bronchial smooth muscle contractility of hyper- and hypothyroid lungs. Clinical and experimental pharmacology & physiology 1992 Dec;19(12):839-42. doi: 10.1111/j.1440-1681.1992.tb00423.x.
Irwin RS, Pratter MR, Stivers DH, Braverman LE. Airway reactivity and lung function in triiodothyronine-induced thyrotoxicosis. Journal of applied physiology 1985 May;58(5):1485-1488. doi: 10.1152/jappl.1985.58.5.1485.
Ismail HM. Reversible pulmonary hypertension and isolated right-sided heart failure associated with hyperthyroidism. Journal of general internal medicine 2007 Jan;22(1):148-150. doi: 10.1007/s11606-006-0032-0.
Marvisi M, Brianti M, Marani G, et al. Hyperthyroidism and pulmonary hypertension. Respiratory Medicine. 2002 Apr;96(4):215-20. doi: 10.1053/rmed.2001.1260.
Doulaptsi M, Karatzanis A, Prokopakis E, et al. Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters. Auris Nasus Larynx. 2019 Apr;46(2):246-251. doi: 10.1016/j.anl.2018.07.006. Epub 2018 Jul 25.
Knobel M. An overview of retrosternal goiter. Journal of endocrinological investigation 2021 Apr;44(4):679-691. doi: 10.1007/s40618-020-01391-6. Epub 2020 Aug 11.
Sundaram P, Joshi JM. Flow volume loops: postural significance. The Indian journal of chest diseases & allied sciences. 1998 Jul-Sep;40(3):201-203.
Ulubay G, Dilektaşlı AG, Börekçi, Ş. et al. Turkish Thoracic Society Consensus Report: Interpretation of Spirometry. Turkish thoracic journal 2019 Jan 1;20(1):69-89. English. doi: 10.5152/TurkThoracJ.2018.180175.
Buckley JA, Stark P. Intrathoracic mediastinal thyroid goiter: Imaging manifestations. American journal of roentgenology 1999;173:471-475.
Samareh Fekri M, Shokoohi M, Gozashti MH, et al. Association between anti-thyroid peroxidase antibody and asthma in women. Iranian journal of allergy, asthma, and immunology. 2012 Sep;11(3):241-5.
Marvisi M, Balzarini L, Mancini C, Mouzakiti P. Thyroid gland and pulmonary hypertension. What's the link? Panminerva Med. 2013 Mar;55(1):93-7.
Ward MJ, Davies D. Riedel’s thyroiditis with invasion of lung Thorax.1981;36:956.
Samaan NA, Schultz PN, Haynie TP, Ordonez NG. Pulmonary metastasis of differentiated thyroid carcinoma: treatment results in 101 patients. The Journal of clinical endocrinology and metabolism. 1985 Feb;60(2):376-80. doi: 10.1210/jcem-60-2-376.
