Boccalandro Cristina, Boccalandro Fernando, Orlander Philip, Wei Chik Fong
Division of Endocrinology and Metabolism, University of Texas at Houston, Houston, Texas, USA.
Endocr Pract. 2003 Mar-Apr;9(2):140-6. doi: 10.4158/EP.9.2.140.
To describe a case of a 46-year-old woman with Graves' disease and reversible low-output congestive heart failure and present a comparative analysis of 23 similar cases reported in the literature.
A detailed case report is presented. In addition, a review of the pertinent literature published between 1960 and 2002 was performed to identify similar cases of dilated cardiomyopathy and thyrotoxicosis and to assess the findings in these patients.
A 46-year-old woman without primary heart disease was admitted to the hospital with Graves' thyrotoxicosis and severe low-output congestive heart failure. Her left ventricular ejection fraction (LVEF) at the time of initial assessment was less than 20%, and her condition was categorized as New York Heart Association (NYHA) functional class III. Nineteen months after she was treated for hyperthyroidism, her LVEF was 49% and her status was NYHA class I. A severe hypotensive episode occurred when b-adrenergic blockade therapy was initiated. The group of 23 similar cases from the literature plus our currently described patient had a mean age of 45 years, a male-to-female ratio of 1:1.2, Graves' disease as the principal cause, and LVEF improvement from 29% to 58%.
Dilated cardiomyopathy is an unusual manifestation of hyperthyroidism with unclear cause. Clinicians should be aware of this entity because it is treatable and hypotension can occur if b-adrenergic blockade treatment is initiated.
描述一例患有格雷夫斯病及可逆性低输出量充血性心力衰竭的46岁女性病例，并对文献报道的23例类似病例进行对比分析。
呈现一份详细的病例报告。此外，对1960年至2002年间发表的相关文献进行综述，以确定扩张型心肌病和甲状腺毒症的类似病例，并评估这些患者的研究结果。
一名无原发性心脏病的46岁女性因格雷夫斯甲状腺毒症和严重的低输出量充血性心力衰竭入院。初始评估时她的左心室射血分数（LVEF）小于20%，其病情被归类为纽约心脏协会（NYHA）功能分级III级。在她接受甲亢治疗19个月后，她的LVEF为49%，状态为NYHA I级。开始β-肾上腺素能阻滞剂治疗时发生了一次严重的低血压发作。文献中的23例类似病例加上我们目前描述的患者，平均年龄为45岁，男女比例为1:1.2，主要病因是格雷夫斯病，LVEF从29%提高到58%。
扩张型心肌病是甲亢的一种不寻常表现，病因不明。临床医生应了解这一情况，因为它是可治疗的，如果开始β-肾上腺素能阻滞剂治疗可能会发生低血压。
