Madan Nidhi, Tiwari Nidhish, Stampfer Morris, Schubart Ulrich
Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
BMJ Case Rep. 2015 Oct 14;2015:bcr2015212045. doi: 10.1136/bcr-2015-212045.
Hypothyroidism may cause several cardiac manifestations including conduction abnormalities, pericardial effusion, decreased myocardial contractility and accelerated coronary atherosclerosis. Although cardiac output is reduced in hypothyroidism, frank heart failure (HF) is relatively rare because of the low peripheral oxygen demand. Several mechanisms have been postulated in hypothyroid-induced HF, including genomic as well as non-genomic actions of thyroid hormone. Dilated cardiomyopathy (DCM) of other aetiologies is usually progressive, and is associated with significant morbidity and mortality. We report a case of DCM associated with severe hypothyroidism with marked improvement on restoration of euthyroid state. Our case is unique in that the patient had no known risk factors for cardiac disease and experienced marked improvement despite being on minimal doses of HF medications, illustrating the relationship between hypothyroidism and development of left ventricular dysfunction, and its reversible nature with restoration of euthyroid status.
甲状腺功能减退可能导致多种心脏表现，包括传导异常、心包积液、心肌收缩力下降和冠状动脉粥样硬化加速。虽然甲状腺功能减退时心输出量会降低，但由于外周氧需求较低，明显的心衰相对少见。甲状腺功能减退所致心衰有多种机制被提出，包括甲状腺激素的基因组及非基因组作用。其他病因所致的扩张型心肌病通常呈进行性发展，并伴有显著的发病率和死亡率。我们报告一例与严重甲状腺功能减退相关的扩张型心肌病病例，甲状腺功能恢复正常后病情显著改善。我们的病例独特之处在于，该患者无已知的心脏病危险因素，且尽管使用的心力衰竭药物剂量极小，仍有显著改善，这说明了甲状腺功能减退与左心室功能障碍发生之间的关系，以及甲状腺功能恢复正常后其可逆的性质。
