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Correspondence |

Idiopathic Pulmonary Fibrosis and Hypothyroidism: Cannot Forget Subclinical Disease and Difficult-to-Eliminate Corticosteroids FREE TO VIEW

Naveen Dutt, MD; Swetabh Purohit, MD; Lokesh Saini, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Naveen Dutt, MD, Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):600. doi:10.1016/j.chest.2015.10.076
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We read with interest the original research entitled “Thyroid Disease is Prevalent and Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis” in CHEST (September 2015). In the study, the authors compared the prevalence of hypothyroidism among patients with idiopathic pulmonary fibrosis (IPF) and control subjects with COPD. They also compared survival among patients with IPF who did or did not have hypothyroidism. In the study, the authors recorded patients as having hypothyroid only when they reported the use of thyroid replacement therapy and did not report a history of thyroidectomy or radioactive iodine ablation. Hypothyroid status was not based on hormone levels. Consequently, some patients with subclinical hypothyroidism could have been missed. Subclinical hypothyroidism is much more prevalent than true hypothyroidism and the prevalence is still higher in the age group for IPF. Although the condition is called subclinical hypothyroidism, frequently patients have nonspecific symptoms such as fatigue. In case of coexisting IPF, such symptoms may be erroneously attributed to IPF and treatment may be denied.

In addition, the authors compared systemic steroids used by patients with IPF and those used by control subjects who had COPD to exclude the possibility of corticosteroids as a cause of hypothyroidism. However, the pattern of systemic steroid use in COPD and IPF is different. In COPD, systemic steroids are usually used for short durations in the setting of an acute exacerbation whereas in IPF, when steroids are used it is for a longer duration, resulting in a higher cumulative dose. Hypothyroidism associated with steroids has been seen to be dose dependent. Thus, corticosteroid use may also be a contributing factor in the increased prevalence of hypothyroidism seen in the study.

References

Oldham J.M. .Kumar D. .Lee C. .et al Thyroid disease is prevalent and predicts survival in patients with idiopathic pulmonary fibrosis. Chest. 2015;148:692-700 [PubMed]journal. [CrossRef] [PubMed]
 
Cooper D.S. . Clinical practice: subclinical hypothyroidism. N Engl J Med. 2001;:- [PubMed]journal
 
Brabant A. .Brabant G. .Schuermeyer T. .et al The role of glucocorticoids in the regulation of thyrotropin. Acta Endocrinol (Copenh). 1989;121:95-100 [PubMed]journal. [PubMed]
 

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References

Oldham J.M. .Kumar D. .Lee C. .et al Thyroid disease is prevalent and predicts survival in patients with idiopathic pulmonary fibrosis. Chest. 2015;148:692-700 [PubMed]journal. [CrossRef] [PubMed]
 
Cooper D.S. . Clinical practice: subclinical hypothyroidism. N Engl J Med. 2001;:- [PubMed]journal
 
Brabant A. .Brabant G. .Schuermeyer T. .et al The role of glucocorticoids in the regulation of thyrotropin. Acta Endocrinol (Copenh). 1989;121:95-100 [PubMed]journal. [PubMed]
 
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