Muthukumar S, Ravikumar K, Dhalapathy S, Gomathy T, Umadevi S, Maruthupandian D
Department of Endocrine Surgery, Madurai Medical College, Madurai, India.
Department of Endocrine Surgery, Madras Medical College, Chennai, India.
World J Surg. 2018 May;42(5):1408-1414. doi: 10.1007/s00268-018-4571-4.
Cardiovascular dysfunction (CVD) is a well-recognized complication in patients with hyperthyroidism and is the major cause of mortality. Very few studies have compared the outcome of CVD following different treatment modalities. In this study we intended to compare treatment modalities (antithyroid drugs vs surgery) for reversal of CVD.
Patients with newly detected hyperthyroidism were grouped into, Group I [n = 123, age <60 years, undergoing total thyroidectomy], Group II [n = 42, age <60 years, treated with antithyroid medications] were evaluated with 2D echocardiography, serum N terminal pro brain natriuretic peptide (NT-pro-BNP) at the time of diagnosis (Point A), after achieving euthyroidism (Point B) with antithyroid drugs and 6 months after surgery/continuation of antithyroid medications (Point C). Forty patients (Group III), age < 60 years, undergoing total thyroidectomy for nontoxic benign thyroid nodules served as controls.
All groups were age and sex matched. At Point A, CVD was evident in 80/123 (65%) in Group I and 28/42 (66.7%) in Group II. At Point B improvement in CVD occurred in 84/123 (68.3%) in Group and 29/42 (69.04%) in Group II. At Point C dramatic improvement in CVD occurred in 118/123 (95.9%) in Group I, whereas only 33/42 (78.5%) improved in Group II. CVD were comparable between Groups I and II at Point A and Point B (p > 0.05). At Point C there was a significant decrease in all the diastolic dysfunction parameters in Group I, whereas the same was not observed in Group II patients. Systolic dysfunction between Groups II and II had no statistical significance at Point C.
Total thyroidectomy seems to be the definitive treatment of choice for hyperthyroid cardiac dysfunction with diastolic dysfunction completely reversing at 6 months after TT.
心血管功能障碍（CVD）是甲状腺功能亢进患者中一种公认的并发症，也是主要的死亡原因。很少有研究比较不同治疗方式后CVD的转归情况。在本研究中，我们旨在比较用于逆转CVD的治疗方式（抗甲状腺药物与手术）。
新诊断为甲状腺功能亢进的患者被分为两组，第一组[n = 123，年龄<60岁，接受全甲状腺切除术]，第二组[n = 42，年龄<60岁，接受抗甲状腺药物治疗]，在诊断时（A点）、使用抗甲状腺药物达到甲状腺功能正常时（B点）以及手术后/继续使用抗甲状腺药物6个月后（C点），通过二维超声心动图、血清N末端脑钠肽前体（NT-pro-BNP）进行评估。40例年龄<60岁、因非毒性良性甲状腺结节接受全甲状腺切除术的患者作为对照组（第三组）。
所有组在年龄和性别上相匹配。在A点，第一组80/123（65%）和第二组28/42（66.7%）存在明显的CVD。在B点，第一组84/123（68.3%）和第二组29/42（69.04%）的CVD有所改善。在C点，第一组118/123（95.9%）的CVD有显著改善，而第二组仅33/42（78.5%）有所改善。在A点和B点，第一组和第二组的CVD情况相当（p>0.05）。在C点，第一组所有舒张功能障碍参数均显著降低，而第二组患者未观察到同样情况。在C点，第二组和第三组之间的收缩功能障碍无统计学意义。
全甲状腺切除术似乎是甲状腺功能亢进性心脏功能障碍的确定性治疗选择，术后6个月舒张功能障碍可完全逆转。
