Musse N S, Albanesi Filho F M, Barbosa E C, Ginefra P
Hospital Universitário Pedro Ernesto, UERJ.
Arq Bras Cardiol. 1992 Nov;59(5):401-4.
A 39-year-old female patient with refractory heart failure has been studied. On February, 1982 she was submitted to right lobar thyroidectomy for remotion of the left thyroid lobe. Following the surgery, she had signs of hypocalcemia and the diagnosis of secondary hypoparathyroidism and heart failure had been made. Seven months after she had acute pulmonary edema, cardiomegaly III (cardiothoracic index = 0.58) with predominant left atrial and left ventricular hypertrophy, which were confirmed by echocardiogram (ECO). The ECO also demonstrated low contractility of the left ventricle. The QT interval was increased on the electrocardiogram (QTc = 0.50 s), the calcium was 5.0 mg/dl with calciuria of 28 mg/day; phosphatemia was 4.8 mg/dl and phosphaturia of 214 mg/day. The level of thyroid hormones (T3 and T4) were in the normal ranges despite the TSH was increased in the beginning of the disease. She was first treated with digitalis, diuretic and vasodilator drugs, thyroid hormone and oral calcium. She had progressive hemodynamic improvement when higher doses of calcium were given with D3 vitamin. The most significant result of this treatment was reduction of the heart size that come back to normal. At the present time patient is treated with thyroid hormone, calcium and D3 vitamin only.
对一名患有难治性心力衰竭的39岁女性患者进行了研究。1982年2月，她接受了右叶甲状腺切除术以切除左甲状腺叶。术后，她出现了低钙血症的症状，并被诊断为继发性甲状旁腺功能减退和心力衰竭。七个月后，她发生了急性肺水肿，心脏增大Ⅲ度（心胸指数=0.58），以左心房和左心室肥厚为主，超声心动图（ECO）证实了这一点。ECO还显示左心室收缩力降低。心电图显示QT间期延长（QTc=0.50秒），血钙为5.0mg/dl，尿钙为28mg/天；血磷为4.8mg/dl，尿磷为214mg/天。尽管疾病初期促甲状腺激素升高，但甲状腺激素（T3和T4）水平在正常范围内。她首先接受了洋地黄、利尿剂、血管扩张剂药物、甲状腺激素和口服钙剂治疗。当给予更高剂量的钙剂和维生素D3时，她的血流动力学有了逐渐改善。这种治疗最显著的结果是心脏大小恢复正常。目前，患者仅接受甲状腺激素、钙剂和维生素D3治疗。
