Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada.
J Crit Care. 2018 Jun;45:140-143. doi: 10.1016/j.jcrc.2018.01.026. Epub 2018 Feb 3.
Thyrotoxicosis-induced cardiomyopathy (TCM) is a rare, potentially life-threatening complication requiring extracorporeal membrane oxygenation (ECMO) for temporary mechanical support while a euthyroid state is being achieved.
The current review searched Ovid Medline and PubMed for all relevant studies reported in English from January 1, 1970 to December 31, 2017. We included studies where patients were diagnosed with thyrotoxicosis, eventually deteriorating into TCM, requiring veno-arterial ECMO. We were predominantly interested in the clinical pathway that led to the initiation and duration of ECMO, including the trend of ejection fraction (EF) pre- and post-ECMO.
The initial search strategy produced 71 articles of which only 5 studies were eligible for inclusion. These 5 articles included 13 case reports. The majority of the patients (77%) survived with complete recovery of their left ventricular function following initiation of VA-ECMO. Key issues in the current management of TCM are delayed recognition of the underlying thyroid hormone imbalance and when to initiate mechanical support.
The definitive therapy of TCM is returning the patient to a euthyroid state. For those patients who develop circulatory collapse, however, temporary mechanical support should be strongly considered to allow time for a euthyroid state to be achieved.
甲状腺毒症性心肌病（TCM）是一种罕见的、潜在危及生命的并发症，需要体外膜氧合（ECMO）进行临时机械支持，直到患者恢复甲状腺功能正常。
本次综述在 Ovid Medline 和 PubMed 上搜索了 1970 年 1 月 1 日至 2017 年 12 月 31 日期间以英文发表的所有相关研究。我们纳入了诊断为甲状腺毒症、最终发展为 TCM、需要静脉-动脉 ECMO 治疗的患者的研究。我们主要关注导致 ECMO 开始和持续的临床途径，包括 ECMO 前后射血分数（EF）的趋势。
最初的搜索策略产生了 71 篇文章，其中只有 5 项研究符合纳入标准。这 5 项研究共纳入了 13 例病例报告。大多数患者（77%）在开始 VA-ECMO 后幸存下来，左心室功能完全恢复。目前 TCM 管理中的关键问题是延迟识别潜在的甲状腺激素失衡以及何时开始机械支持。
TCM 的明确治疗方法是使患者恢复甲状腺功能正常。然而，对于那些出现循环衰竭的患者，应强烈考虑临时机械支持，以争取时间使患者恢复甲状腺功能正常。
