Bergeron G A, Goldsmith R, Schiller N B
Department of Medicine, University of California, San Francisco.
Arch Intern Med. 1988 Jun;148(6):1450-3.
In the absence of fixed coronary artery disease, thyrotoxicosis is rarely associated with acute myocardial infarction and/or ischemia. There are no known reports on the association of acute myocardial infarction with iatrogenic or factitious thyrotoxicosis in the absence of fixed coronary artery stenosis or coronary artery spasm. A 68-year-old woman, clinically in a state of thyrotoxicosis as a result of taking 0.3 g/d of exogenous thyroid replacement, sustained a severe, reversible myocardial ischemic event. Echocardiographic and scintigraphic evaluations demonstrated a large apical dyskinetic region. Subsequently, after the original dose of levothyroxine sodium was reduced to 0.15 mg and the patient became euthyroid, two-dimensional echocardiography and scintigraphic and cardiac catheterization studies demonstrated normal left ventricular contractility and normal coronary anatomy. Coronary artery spasm was not induced by ergonovine maleate therapy. Exogenous thyroid administration may directly influence myocardial oxygen supply and demand, exclusive of coronary artery disease and coronary spasm. A critical imbalance may then result in acute myocardial ischemia and reversible left ventricular segmental wall motion abnormalities.
在无固定性冠状动脉疾病的情况下，甲状腺毒症很少与急性心肌梗死和/或缺血相关。在无固定性冠状动脉狭窄或冠状动脉痉挛的情况下，关于急性心肌梗死与医源性或人为性甲状腺毒症之间关联的报道尚无。一名68岁女性，因每日服用0.3 g外源性甲状腺替代药物而处于临床甲状腺毒症状态，发生了一次严重的、可逆性心肌缺血事件。超声心动图和闪烁扫描评估显示心尖部有一大片运动障碍区域。随后，在将左甲状腺素钠的原始剂量减至0.15 mg且患者甲状腺功能恢复正常后，二维超声心动图、闪烁扫描及心导管检查显示左心室收缩功能正常且冠状动脉解剖结构正常。马来酸麦角新碱治疗未诱发冠状动脉痉挛。外源性甲状腺给药可能直接影响心肌的氧供需，而与冠状动脉疾病和冠状动脉痉挛无关。进而可能导致严重失衡，引发急性心肌缺血和可逆性左心室节段性室壁运动异常。
