Anderton Thomas S, Saunderson Christopher E D, Jain Manali, Sengupta Anshuman
Department of Cardiology, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
Eur Heart J Case Rep. 2020 Dec 12;4(6):1-5. doi: 10.1093/ehjcr/ytaa465. eCollection 2020 Dec.
The effects of hyperthyroidism on the heart are well documented, primarily consisting of supraventricular tachycardias, congestive heart failure, and dilated cardiomyopathy. Acute myopericarditis resulting from a hyperthyroid state is an uncommon but recognized association.
A 29-year-old man with a history of Graves' disease presented with chest pain and electrocardiogram changes suggestive of an infero-lateral ST-elevation myocardial infarction. However, emergent coronary angiography and bedside echocardiography were normal. Troponin-I was found to be >25 000 ng/L (normal value <57). Thyroid function tests showed a significantly raised free T4 and undetectable thyroid-stimulating hormone. Cardiovascular magnetic resonance (CMR) showed extensive myocardial oedema and late gadolinium enhancement (LGE) in keeping with acute myopericarditis, alongside an enlarged thyroid gland consistent with goitre. Propylthiouracil in combination with an angiotensin-converting enzyme inhibitor and beta-blocker were commenced and eventually definitive treatment with thyroidectomy was performed. Follow-up CMR at 6 months showed complete resolution of the prior noted oedema and a reduction in the location and extent of LGE with significant residual fibrosis.
Acute myopericarditis is a common diagnosis in young patients presenting with symptoms of chest pain with elevated troponin and is frequently related to a viral illness. Hyperthyroid states are also associated with acute myopericarditis and should be particularly considered in patients with a pre-existing thyroid condition or in those with symptoms suggestive of hyperthyroidism. Given the specific treatments required in a case of myopericarditis associated with hyperthyroidism, it is important to be aware of this association and consider screening where appropriate.
甲状腺功能亢进对心脏的影响已有充分记录，主要包括室上性心动过速、充血性心力衰竭和扩张型心肌病。甲状腺功能亢进状态导致的急性心肌心包炎虽不常见，但已得到认可。
一名有格雷夫斯病病史的29岁男性因胸痛和心电图改变就诊，提示下后壁ST段抬高型心肌梗死。然而，急诊冠状动脉造影和床旁超声心动图均正常。肌钙蛋白I水平>25000 ng/L（正常值<57）。甲状腺功能检查显示游离T4显著升高，促甲状腺激素检测不到。心血管磁共振成像（CMR）显示广泛的心肌水肿和钆延迟强化（LGE），符合急性心肌心包炎表现，同时甲状腺肿大符合甲状腺肿。开始使用丙硫氧嘧啶联合血管紧张素转换酶抑制剂和β受体阻滞剂治疗，最终进行了甲状腺切除术的确定性治疗。6个月后的随访CMR显示先前记录的水肿完全消退，LGE的部位和范围减小，仍有明显的残余纤维化。
急性心肌心包炎是年轻患者出现胸痛症状且肌钙蛋白升高时的常见诊断，通常与病毒感染有关。甲状腺功能亢进状态也与急性心肌心包炎有关，对于既往有甲状腺疾病或有甲状腺功能亢进症状的患者应特别考虑。鉴于甲状腺功能亢进相关的心肌心包炎病例需要特定的治疗，了解这种关联并在适当情况下考虑筛查很重要。
