An overlooked aspect in the assessment of systolic pulmonary arterial pressure in female patients with hyperthyroidism

I read the article entitled “Echocardiographic evolution of pulmonary hypertension in female patients with hyperthyroidism” with great interest (1). The authors have demonstrated that pulmonary hypertension (PH), with various severities, was present in 73 of the total 142 female patients with hyperthyroidism. To detect PH in the study population, estimated systolic pulmonary arterial pressure (sPAP) was measured by transthoracic echocardiography (TTE). Moreover, patients who had an estimated sPAP ≥35 mm Hg at rest were considered to have PH. I commend the authors for their complementary contribution to the area of PH in patients with hyperthyroidism. PH is defined as an increase in mean PAP ≥25 mm Hg at rest, as assessed by right heart catheterization (RHC) (2). Thus, RHC is considered the gold standard for the diagnosis of PH. However, TTE is recommended for screening for the presence of PH (2). Therefore, TTE is frequently used to estimate sPAP, to screen for PH, and to monitor progression over time because it is noninvasive, widely available, and relatively inexpensive.