Taguchi Takafumi, Iwasaki Yasumasa, Asaba Koichi, Takao Toshihiro, Hashimoto Kozo
Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Nankoku, Japan.
Clin Ther. 2007 Dec;29(12):2710-4. doi: 10.1016/j.clinthera.2007.12.025.
Although thyroid hormone deficiency, either clinical or subclinical, is an established risk factor for cardiovascular disease, coronary ischemia in a premenopausal woman in her 30s is relatively rare.
A 38-year-old woman was referred to our hospital with severe breathlessness and depressed consciousness. Physical examination found facial, abdominal, and pretibial edema; coarse hair, hoarse voice, and dry skin; engorged jugular veins; a distant heart sound; and reduced bilateral entry of air into the chest. Laboratory examinations revealed severe hypothyroidism, hyperlipidemia, and elevated serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125). A computed tomography scan showed massive pleural and pericardial effusions. After 3 months of levothyroxine replacement therapy (initial dose: 12.5 microg/d; maintenance dose: 125 microg/d), all abnormal laboratory values associated with hypothyroidism returned to within normal ranges, with the exception of a transient and paradoxical rise in serum thyroid-stimulating hormone levels. However, 3 weeks after the initiation of therapy, the patient reported intermittent chest pains during the course of therapy, and a coronary artery angiogram revealed diffuse stenosis of all 3 branches. The patient underwent coronary artery bypass grafting, with subsequent improvement in coronary perfusion.
Careful cardiovascular evaluation is recommended before the start of thyroid hormone replacement therapy. In addition, care should be taken in the interpretation of serum biomarkers of malignancy (eg, CEA, CA125) in patients with myxedema, as values may be elevated in a hypothyroid state.
Long-standing hypothyroidism may be associated with severe coronary atherosclerosis, even in a relatively young, premenopausal woman. The potential adverse cardiovascular effects of thyroid hormone must be considered during replacement therapy, even in relatively young patients.
尽管临床或亚临床甲状腺激素缺乏是心血管疾病的既定危险因素，但30多岁的绝经前女性发生冠状动脉缺血相对罕见。
一名38岁女性因严重呼吸困难和意识不清被转诊至我院。体格检查发现面部、腹部和胫前水肿；毛发粗糙、声音嘶哑和皮肤干燥；颈静脉怒张；心音遥远；双侧胸廓呼吸音减弱。实验室检查显示严重甲状腺功能减退、高脂血症以及血清癌胚抗原（CEA）和糖类抗原125（CA125）水平升高。计算机断层扫描显示大量胸腔和心包积液。经过3个月的左甲状腺素替代治疗（初始剂量：12.5微克/天；维持剂量：125微克/天），除血清促甲状腺激素水平出现短暂且矛盾的升高外，所有与甲状腺功能减退相关的异常实验室值均恢复至正常范围。然而，治疗开始3周后，患者在治疗过程中出现间歇性胸痛，冠状动脉血管造影显示三支血管均有弥漫性狭窄。患者接受了冠状动脉搭桥手术，冠状动脉灌注随后得到改善。
建议在开始甲状腺激素替代治疗前进行仔细的心血管评估。此外，对于黏液性水肿患者，在解读恶性肿瘤血清生物标志物（如CEA、CA125）时应谨慎，因为在甲状腺功能减退状态下这些值可能会升高。
即使是相对年轻的绝经前女性，长期甲状腺功能减退也可能与严重的冠状动脉粥样硬化有关。在替代治疗期间，即使是相对年轻的患者，也必须考虑甲状腺激素潜在的不良心血管影响。
