Yang Jeong Hoon, Jang Hye Won, Park Sung-Ji, Park Seung Woo
Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cardiology. 2011;119(1):38-42. doi: 10.1159/000329839. Epub 2011 Jul 29.
A 57-year-old woman was referred for cardiomegaly on a chest X-ray taken during thyroxine withdrawal for radioiodine therapy after total thyroidectomy. Baseline transthoracic echocardiography showed left ventricular (LV) wall motion abnormalities and an LV apical mural thrombus. Coronary angiography revealed normal epicardial coronary arteries. Despite anticoagulation treatment, the patient developed abrupt aphasia, agraphia and acalculia. The distal branch of the inferior segmental branch on the left middle cerebral artery was not well visualized on magnetic resonance angiography. Three days later, the patient had made a near full neurological recovery. After 4 weeks of anticoagulation therapy, the apical mural thrombus and wall motion abnormalities resolved. This is the first reported case in the medical literature of transient LV systolic dysfunction with thrombus and subsequent cardioembolic stroke in a patient with short-term overt hypothyroidism.
一名57岁女性在全甲状腺切除术后因放射性碘治疗停用甲状腺素期间拍摄的胸部X线片显示心脏增大而前来就诊。基线经胸超声心动图显示左心室（LV）壁运动异常及左心室心尖部壁内血栓形成。冠状动脉造影显示心外膜冠状动脉正常。尽管进行了抗凝治疗，患者仍突发失语、失写和失算。磁共振血管造影显示左侧大脑中动脉下部分支远端未清晰显影。三天后，患者神经功能几乎完全恢复。抗凝治疗4周后，心尖部壁内血栓及壁运动异常消失。这是医学文献中首次报道的短期明显甲状腺功能减退患者出现短暂性左心室收缩功能障碍伴血栓形成及随后发生心脏栓塞性卒中的病例。
