Molinaro Giuseppina, De Vecchis Renato, Badolati Elio, Giannattasio Raffaele
UOC Internal Medicine, The Pellegrini Hospital, Naples, Italy.
Medical and Polyspecialist Centre, Department of Cardiology, DSB 29 "S.Gennaro dei Poveri Hospital", Naples, Italy.
Endocrinol Diabetes Metab Case Rep. 2020 Dec 24;2020. doi: 10.1530/EDM-20-0068.
The authors examine several reports of the literature concerning thyrotoxic dilated cardiomyopathy. In particular, it is pointed out that this clinical manifestation of hyperthyroidism is rare in readily diagnosed and properly treated hyperthyroidism. Case reports are analyzed comparatively. A case deriving from the direct experience of the authors is also presented.
Dilated cardiomyopathy has been reported as the initial presentation of hyperthyroidism in only 6% of patients although <1% developed severe LV dysfunction. Clinical picture of thyrotoxic dilated cardiomyopathy can degenerate into an overt cardiogenic shock sometimes requiring the use of devices for mechanical assistance to the circulation, or extracorporeal membrane oxygenation. For thyrotoxic dilated cardiomyopathy, evidence-based pharmacologic measures valid for heart failure should always be supplemented by the administration of specific thyroid therapies such as thionamides (methimazole, carbimazole or propylthiouracil), whose relatively long latency of action should be supported by the i.v. administration of small doses of beta-blocker. In cases of cardiogenic shock, the administration of beta-blocker should be carried out only after the restoration of satisfactory blood pressure levels- with the prudent use of synthetic catecholamines, if necessary.
作者研究了有关甲状腺毒症性扩张型心肌病的几篇文献报道。特别指出，这种甲状腺功能亢进的临床表现在易于诊断和正确治疗的甲状腺功能亢进症中很少见。对病例报告进行了比较分析。还介绍了作者直接经验中的一个病例。
据报道，扩张型心肌病仅在6%的患者中作为甲状腺功能亢进症的初始表现出现，尽管不到1%的患者出现严重的左心室功能障碍。甲状腺毒症性扩张型心肌病的临床表现有时会恶化为明显的心源性休克，有时需要使用循环机械辅助装置或体外膜肺氧合。对于甲状腺毒症性扩张型心肌病，对心力衰竭有效的循证药理学措施应始终辅以特定的甲状腺治疗，如硫代酰胺类药物（甲巯咪唑、卡比马唑或丙硫氧嘧啶），其相对较长的起效潜伏期应由静脉注射小剂量β受体阻滞剂来支持。在心源性休克的情况下，仅在恢复满意的血压水平后才可使用β受体阻滞剂——如有必要，谨慎使用合成儿茶酚胺类药物。
