van de Donk N W C J, America Y G C J, Zelissen P M J, Hamer B J B
Department of Hematology, University Medical Centre Utrecht, the Netherlands.
Neth J Med. 2009 Nov;67(10):350-2.
We report on a 73-year-old man with a toxic multinodular goitre, which was treated with radioiodine therapy (I-131) without pretreatment with an antithyroid drug. Four weeks later he presented with rapidly progressive dyspnoea and a significant increase in free thyroxin. The electrocardiogram showed ST -segment elevation, and echocardiography demonstrated apical akinesia and a left ventricular ejection fraction of only 25%. However, direct coronary catheterisation showed no evidence of coronary artery disease. Left ventricular angiography showed apical ballooning consistent with the diagnosis of takotsubo cardiomyopathy. Following treatment of the cardiomyopathy and thyrotoxicosis, he experienced a complete recovery. To the best of our knowledge, this is the first report of a takotsubo cardiomyopathy associated with thyrotoxicosis resulting from radiation thyroiditis induced by radioiodine. Three other cases of takotsubo cardiomyopathy associated with Graves' disease have been described in literature.
我们报告了一名73岁患有毒性多结节性甲状腺肿的男性患者，该患者接受了放射性碘治疗（I-131），未预先使用抗甲状腺药物。四周后，他出现了快速进展的呼吸困难，游离甲状腺素显著升高。心电图显示ST段抬高，超声心动图显示心尖运动减弱，左心室射血分数仅为25%。然而，直接冠状动脉导管插入术未显示冠状动脉疾病的证据。左心室血管造影显示心尖部气球样改变，符合应激性心肌病的诊断。在对心肌病和甲状腺毒症进行治疗后，他完全康复。据我们所知，这是首例与放射性碘诱发的放射性甲状腺炎导致的甲状腺毒症相关的应激性心肌病报告。文献中还描述了另外3例与格雷夫斯病相关的应激性心肌病病例。
