Dahl Peter, Danzi Sara, Klein Irwin
Curr Heart Fail Rep. 2008 Sep;5(3):170-6. doi: 10.1007/s11897-008-0026-9.
The most recognizable features of hyperthyroidism are those that result from the effects of triiodothyronine (T3) on the heart and cardiovascular system: decreased systemic vascular resistance and increased resting heart rate, left ventricular contractility, blood volume, and cardiac output. Although these measures of cardiac performance are enhanced in hyperthyroidism, the finding of clinical cardiac failure can be somewhat paradoxical. About 6% of thyrotoxic individuals develop symptoms of heart failure, but less than 1% develop dilated -cardiomyopathy with impaired left ventricular systolic function. Heart failure resulting from thyrotoxicosis is due to a tachycardia-mediated mechanism leading to an increased level of cytosolic calcium during diastole with reduced ventricular contractility and diastolic dysfunction, often with tricuspid regurgitation. Pulmonary artery hypertension in thyrotoxicosis is gaining awareness as a cause of isolated right-sided heart failure. In both cases, older individuals are more likely to be affected. Treatment needs to be directed at management of the acute cardiovascular complications, control of the heart rate, and thyroid-specific therapy to restore a euthyroid state that will lead to resolution of the signs and symptoms of heart failure.
甲状腺功能亢进最易识别的特征是那些由三碘甲状腺原氨酸（T3）对心脏和心血管系统产生的影响所导致的特征：全身血管阻力降低，静息心率、左心室收缩力、血容量和心输出量增加。尽管在甲状腺功能亢进时这些心脏功能指标有所增强，但临床心力衰竭的发现可能有点自相矛盾。约6%的甲状腺毒症患者会出现心力衰竭症状，但不到1%的患者会发展为左心室收缩功能受损的扩张型心肌病。甲状腺毒症导致的心力衰竭是由于心动过速介导的机制，导致舒张期胞浆钙水平升高，心室收缩力降低和舒张功能障碍，常伴有三尖瓣反流。甲状腺毒症中的肺动脉高压作为孤立性右心衰竭的一个病因正日益受到关注。在这两种情况下，老年个体更容易受到影响。治疗需要针对急性心血管并发症的管理、心率控制以及甲状腺特异性治疗，以恢复甲状腺功能正常状态，从而消除心力衰竭的体征和症状。
