Kandan Sri Raveen, Saha Mrinal
Gloucestershire Royal Hospital, Gloucester, UK.
BMJ Case Rep. 2012 Sep 17;2012:bcr1220115306. doi: 10.1136/bcr.12.2011.5306.
An 85-year-old lady presented to our institution following multiple episodes of transient loss of consciousness. Her admission ECG revealed a junctional bradycardia with significant QT prolongation. Telemetry captured a torsades de pointes arrhythmia. Possible offending drugs (digoxin and hydroxychloroquine) were stopped and she was given intravenous magnesium and potassium. Despite this, she continued to have runs of torsades. An isoprenaline infusion was commenced to increase her resting heart rate. Her QT interval shortened and she had no further arrhythmia. Investigation into the cause of her bradycardia and prolonged QT revealed profound hypothyroidism. Levothyroxine was commenced but the patient remained bradycardia and required a permanent pacemaker. She had no further arrhythmia and was discharged home safely. This is a very rare case of severe primary hypothyroidism presenting with torsades de pointes.
一位85岁女性在多次短暂意识丧失后前来我院就诊。她入院时的心电图显示交界性心动过缓，伴有明显的QT间期延长。遥测记录到尖端扭转型室性心动过速心律失常。停用了可能引起问题的药物（地高辛和羟氯喹），并给予静脉注射镁和钾。尽管如此，她仍反复发作尖端扭转型室性心动过速。开始静脉输注异丙肾上腺素以提高其静息心率。她的QT间期缩短，未再出现心律失常。对其心动过缓和QT间期延长原因的调查显示为严重甲状腺功能减退。开始使用左甲状腺素，但患者仍心动过缓，需要植入永久性起搏器。此后她未再出现心律失常，安全出院。这是一例非常罕见的以尖端扭转型室性心动过速为表现的严重原发性甲状腺功能减退病例。
