Arnautovic Jelena Z, Connor-Schuler Randi, Ip Randy
Division of Cardiovascular Medicine, St. John Providence Ascension Health System, Warren, MI, USA.
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
Case Rep Cardiol. 2019 Mar 6;2019:2595736. doi: 10.1155/2019/2595736. eCollection 2019.
The cardiovascular system is a major target of thyroid hormone action and the two systems are closely interlinked. It can be greatly impacted even with subtle alterations in thyroid function. Caution is needed when implementing thyroid hormone replacement in patients with severe hypothyroidism, especially in the setting of ischemic coronary artery disease. If not properly treated, myxedema may ensue. Given the high mortality of myxedema coma, supportive care may not always suffice and patients may require more invasive interventions. We present a challenging case of a patient with overt hypothyroidism with concurrent acute coronary syndrome which subsequently lead to myxedema coma and cardiogenic shock. A transcaval approach for the delivery of an Impella 5.0 (Abiomed Inc., Danvers, MA) was utilized in supporting this patient. To our knowledge, this is the first reported case that describes the use of a mechanical circulatory support in treating myxedema-induced cardiovascular collapse.
心血管系统是甲状腺激素作用的主要靶点，这两个系统紧密相连。即使甲状腺功能有细微改变，心血管系统也会受到很大影响。在重度甲状腺功能减退患者中实施甲状腺激素替代治疗时需要谨慎，尤其是在缺血性冠状动脉疾病的情况下。如果治疗不当，可能会发生黏液性水肿。鉴于黏液性水肿昏迷的高死亡率，支持性护理可能并不总是足够的，患者可能需要更具侵入性的干预措施。我们报告了一例具有挑战性的病例，该患者患有明显的甲状腺功能减退症并并发急性冠状动脉综合征，随后导致黏液性水肿昏迷和心源性休克。采用经腔途径植入Impella 5.0（美国马萨诸塞州丹弗斯市的Abiomed公司）来支持该患者。据我们所知，这是首例报道使用机械循环支持治疗黏液性水肿所致心血管衰竭的病例。
