Singarayar Carolina Shalini, Siew Hui Foo, Cheong Nicholas, Swee En Goay
Endocrine Unit, Department of Medicine, Selayang Hospital, Selangor, Malaysia.
Endocrinol Diabetes Metab Case Rep. 2018 May 16;2018. doi: 10.1530/EDM-18-0012. eCollection 2018.
Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves' disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure.
Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy.Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis.Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes.Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure.
甲状腺毒症与心脏功能障碍相关；更常见的是左心室功能障碍。然而，近年来，有更多关于右心室功能障碍的病例报道，常与甲状腺毒症患者的肺动脉高压相关。本文介绍了3例与右心室功能障碍相关的甲状腺毒症病例。同时回顾了1994年至2017年发表的另外25例与右心室功能障碍相关的甲状腺毒症病例以及当前的3例病例。平均年龄为45岁。大多数（82%）病例为新诊断的甲状腺毒症。女性占优势（71%），潜在病因以格雷夫斯病为主（86%）。常见的临床表现包括呼吸困难、疲劳和脚踝水肿。50%的病例报告有房颤。几乎所有病例的超声心动图显示右心房和/或心室腔扩大，肺动脉压力升高。大多数病例在使患者甲状腺功能正常后，超声心动图异常参数得到改善。右心室功能障碍和肺动脉高压是甲状腺毒症未被充分认识的并发症。它们是危及生命的情况，可通过早期识别和治疗甲状腺毒症得到逆转。对于所有新诊断的甲状腺毒症患者，应寻找右心室功能障碍的体征和症状，对于受影响的患者，在出现明显右心衰竭之前，应及时恢复甲状腺功能正常。
除了典型甲状腺毒症性心肌病中描述的左心室功能障碍外，甲状腺毒症还与右心室功能障碍和肺动脉高压相关。对于所有新诊断的甲状腺毒症患者，应寻找右心室功能障碍和肺动脉高压的症状和体征。对于所有右心室功能障碍或肺动脉高压病例，如果不能轻易用其他原因解释，应考虑甲状腺毒症。对于合并右心室功能障碍伴或不伴肺动脉高压的甲状腺毒症患者，应及时恢复甲状腺功能正常，以便在出现明显右心衰竭之前及时解决异常心脏参数。
