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Thyroid Science 4(8):CLS1-5, 2009

Clinical Utility of
Thyroperoxidase Antibody Testing in
Patients with Pulmonary Hypertension

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Justin J. Gisel, MD, John T. Daniels, DO, and Charles D. Burger, MD*

Department of Pulmonary and Critical Care, Mayo Clinic Jacksonville

*Correspondence: Charles D. Burger, MD, Pulmonary and Critical Care Division,
Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224
Ph: 904-953-2000 Fax: 904-953-2082

Abstract. Background: The association of autoimmune thyroid disease (AITD) in patients with pulmonary arterial hypertension (PAH) has been well-recognized, yet the best method to screen for thyroid disease is unclear. Since there may be an underlying common immunopathologic link, we sought to determine whether testing for thyroperoxidase antibody (TPOAb) would be a useful screening tool for AITD in PAH. Methods: This retrospective study comprised 101 consecutive PAH patients seen at Mayo Clinic Jacksonville’s Pulmonary Hypertension Center from 2001 to 2008 who fulfilled two requirements: they met the WHO criteria for PAH, and they had measurements of TPOAb levels and thyroid stimulating hormone (TSH). Results: Of the 101 patients in the cohort, 37 met criteria for AITD. Two patients had an elevated level of TPOAb in the setting of a normal TSH and not taking thyroid hormone medication. TPOAb sensitivity was 46% (95% confidence interval [CI], 29 to 63%), specificity 97% (95% CI 89 to 99%), positive predictive value (PPV) was 89% (95% CI 67 to 98%), and negative predictive value (NPV) was 76%(95% CI 65 to 84%). Conclusions: Many patients with PAH have a concomitant thyroid disorder. Screening for TPOAb revealed elevated levels in approximately half of those with AITD and PAH. However, TPOAb was elevated in only 2 patients with both a normal TSH and no prior diagnosis of thyroid disease. The low sensitivity of TPOAb demonstrates limited value as a screening test for thyroid disease compared to a medical history and a
measurement of TSH.

Keywords. Thyroperoxidase • Antibody • Pulmonary hypertension • Thyroid • Autoimmune

Gisel, J.J., Daniels, J.T., and Burger, C.D.: Clinical and Lab Studies Clinical Utility of Thyroperoxidase Antibody Testing in Patients with Pulmonary Hypertension. Thyroid Science,
4(8):CLS1-5, 2009.

Full Text Free in pdf format

© 2009 Thyroid Science