End-tidal CO(2) levels lower in subclinical and overt hypothyroidism than healthy controls; no relationship to thyroid function tests

Khalil Ansarin; Babak Niroomand; Farzad Najafipour; Naser Aghamohammadzadeh; Mitra Niafar; Akbar Sharifi; Mohammadali M Shoja

doi:10.2147/IJGM.S16252

End-tidal CO(2) levels lower in subclinical and overt hypothyroidism than healthy controls; no relationship to thyroid function tests

Int J Gen Med. 2011 Jan 7:4:29-33. doi: 10.2147/IJGM.S16252.

Authors

Khalil Ansarin¹, Babak Niroomand, Farzad Najafipour, Naser Aghamohammadzadeh, Mitra Niafar, Akbar Sharifi, Mohammadali M Shoja

Affiliation

¹ Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. kansarin@yahoo.com

Abstract

Background: Hypoventilation is a frequently suspected complication of hypothyroidism.

Objective: In this study we examined the hypothesis that changes in alveolar ventilation, as measured by end-tidal carbon dioxide (Et-CO(2)), differ between patients with mild (subclinical) and overt (clinical) thyroid hormone deficiency, and both differ from healthy control subjects.

Methods: A total of 95 subjects, including 33 with subclinical hypothyroidism (an elevated thyroid-stimulating hormone (TSH) level and a normal thyroxin (fT(4)) level), 31 with overt hypothyroidism (elevated TSH and decreased fT(4)), and 31 healthy controls. All subjects were female and were evaluated clinically by an endocrinologist for evidence of thyroid disease and categorized on the basis of thyroid hormone levels. Et-CO(2) was measured using a capnograph. Et-CO(2) levels were measured three times and the mean value was considered as the mean level for the individual.

Results: Mean Et-CO(2) values of the subclinical hypothyroidism group were significantly lower than those of the healthy controls (31.79 ± 2.75 vs 33.81 ± 2.38; P = 0.01). Moreover, mean Et-CO(2) values for the overt hypothyroidism group were significantly lower than those for healthy controls (32.13 ± 3.07 vs 33.81 ± 2.38; P = 0.04). There was a significant correlation between Et-CO(2) values and TSH levels (r = -0.24; P = 0.01). However, Et-CO(2) values were not correlated with fT(4) levels (r = 0.13; P = 0.20).

Conclusions: Alveolar ventilation, as inferred from lower Et-CO(2) levels, is higher in subjects with subclinical hypothyroidism and overt hypothyroidism (lower Et-CO(2)) than in healthy controls. Furthermore, Et-CO(2) levels have no relationship to the levels of TSH or fT(4). The lower Et-CO(2) in these patients with hypothyroidism, particularly at the subclinical stage, suggests presence of hyperventilation, which may be related to direct effect of TRH on respiratory center or to local changes within the lung.

Keywords: end-tidal CO2; hypothyroidism; lung; respiratory; ventilation.