Thyroid disfunction and chronic obstructive pulmonary disease: case report

Common concomitant endocrine diseases in chronic obstructive pulmonary disease (COPD) patients include both structural and functional lesions of the thyroid gland.

The purpose of the study was to determine specific indicators for the differential diagnosis of thyroid storm and exacerbation of COPD. A clinical observation of a 60-year-old patient who received inpatient treatment in the therapeutic department of a city clinical hospital is presented. The diagnosis upon admission was COPD, mixed form, severe, exacerbation, and respiratory failure of the first degree.

Results. In the hospital, the patient experienced an episode of difficulty breathing lasting 45 minutes. Increased shortness of breath alternated with normal breathing and was accompanied by tremor of the hands. The patient was agitated, refused to breathe oxygen through the mask, and was in orthopnea. The patient’s condition during the attack was assessed at 40 points according to the Burch – Wartofsky scale, which corresponds to a high probability of thyroid storm (TS). Pronounced ventilation disturbances of a mixed type were recorded based on the spirography results (forced expiratory volume in 1 second – 19%). Echocardiography revealed no signs of cor pulmonale or pulmonary hypertension. A low concentration of thyroid-stimulating hormone was recorded, the level of free thyroxine (T4) remained within the reference range. Serum levels of thyroid peroxidase antibodies did not increase, and no changes in the thyroid gland were detected during ultrasound examination.

Conclusion. When thyroid abnormality manifests in a patient with COPD, certain difficulties may arise with the differential diagnosis of exacerbation of COPD and TS due to the similarity of their clinical manifestations.

1. Christenson S.A., Smith B.M., Bafadhel M., Putcha N. Chronic obstructive pulmonary disease. Lancet. 2022; 399 (10342): 2227–2242. DOI: 10.1016/S0140-6736(22)00470-6.

2. World Health Organization. Chronic obstructive pulmonary disease (COPD). Available at: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

3. Vogelmeier C.F., Criner G.J., Martinez F.J. et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report: GOLD executive summary. Eur. Respir. J. 2017; 49 (3): 1700214. DOI: 10.1183/13993003.00214-2017.

4. Huertas A., Palange P. COPD: a multifactorial systemic disease. Ther. Adv. Respir. Dis. 2011; 5 (3): 217–224. DOI: 10.1177/1753465811400490.

5. Ilievska D.B., Mickovski I. Comorbidities of patients with chronic obstructive pulmonary disease (COPD): thyroid abnormalities in stable COPD. Med. Res. J. 2021; 6 (3): 204–210. DOI: 10.5603/MRJ.a2021.0040.

6. Chaudhary S.C., Ahmad T., Usman K. et al. Prevalence of thyroid dysfunction in chronic obstructive pulmonary disease patients in a tertiary care center in North India. J. Family Med. Prim. Care. 2018; 7 (3): 584–588. DOI: 10.4103/jfmpc.jfmpc_84_17.

7. Gumus A., Ozcelik N., Yilmaz Kara B. et al. Thyroid gland disease as a comorbid condition in COPD. Pulm. Med. 2021; 2021: 7479992. DOI: 10.1155/2021/7479992.

8. Sukholytka M. Hypothyroidism and chronic obstructive pulmonary disease. Міжнародний ендокринологічний журнал. 2020; 16 (8): 643–647. Available at: https://cyberleninka.ru/article/n/hypothyroidism-and-chronic-obstructive-pulmonary-disease/viewer

9. Aisanov Z.R., Avdeev S.N., Arkhipov V.V. et al. [National clinical guidelines on diagnosis and treatment of chronic obstructive pulmonary disease: a clinical decision-making algorithm]. Pul'monologiya. 2017; 27 (1): 13–20. DOI: 10.18093/0869-0189-2017-27-1-13-20 (in Russian).

10. Pahal P., Hashmi M.F., Sharma S. Chronic obstructive pulmonary disease compensatory measures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://pubmed.ncbi.nlm.nih.gov/30247837/

11. Cassady S.J., Reed R.M. Pulmonary hypertension in COPD: a case study and review of the literature. Medicina (Kaunas). 2019; 55 (8): 432. DOI: 10.3390/medicina55080432.

12. Chuchalin A.G., Avdeev S.N., Aisanov Z.R.et al. [Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease]. Pul'monologiya. 2022; 32 (3): 356–392. DOI: 10.18093/0869-0189-2022-32-3-356-392 (in Russian).

13. Nai Q., Ansari M., Pak S. et al. Cardiorespiratory failure in thyroid storm: case report and literature review. J. Clin. Med. Res. 2018; 10 (4): 351–357. DOI: 10.14740/jocmr3106w.

14. Pokhrel B., Aiman W., Bhusal K. Thyroid Storm. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available at https://www.ncbi.nlm.nih.gov/books/NBK448095/

15. Galindo R.J., Hurtado C.R., Pasquel F.J. et al. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004–2013. Thyroid. 2019; 29 (1): 36–43. DOI: 10.1089/thy.2018.0275.

16. Burch H.B., Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol. Metab. Clin. North Am. 1993; 22 (2): 263–277. DOI: 10.1016/S0889-8529(18)30165-8.

17. Gazizova O.D., Vasichkin S.V., Kharkenen P.O. et al. [Thyrotoxic crisis: rare manifestations and the difficulties of timely diagnostics]. Klinicheskaya i eksperimental'naya tireoidologiya. 2015; 11 (1): 59–67. DOI: 10.14341/ket2015159-67 (in Russian).

18. Terzano C. Romani S.; Paone G. et al. COPD and thyroid dysfunctions. Lung. 2014; 192 (1): 103–109. DOI: 10.1007/s00408-013-9537-6.