Wu Lujin, Wang Wei, Leng Qianru, Tang Nana, Zhou Ning, Wang Yan, Wang Dao Wen
Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2021 Jul 7;8:678645. doi: 10.3389/fcvm.2021.678645. eCollection 2021.
The manifestations of hyperthyroidism-related myocardial damage are multitudinous, including arrhythmia, dilated cardiomyopathy, valvular diseases, and even cardiogenic shock. Acute myocarditis induced by thyrotoxicosis had been reported in a few studies. However, attention on its prevalence and underlying mechanisms is sorely lacking. Its long-term harm is often ignored, and it may eventually develop into dilated cardiomyopathy and heart failure. We report a case of Graves' disease with a progressive elevation of hypersensitive cardiac troponin-I at several days after discontinuation of the patient's anti-thyroid drugs. Cardiac magnetic resonance imaging (CMRI) showed inflammatory edema of some cardiomyocytes (stranded enhanced signals under T2 mapping), myocardial necrosis (scattered enhanced signals under T1 late gadolinium enhancement) in the medial and inferior epicardial wall, with a decreased left ventricular systolic function (48%), which implied a possibility of acute myocarditis induced by thyrotoxicosis. The patient was then given a transient glucocorticoid (GC) treatment and achieved a good curative effect. Inspired by this case, we aim to systematically elaborate the pathogenesis, diagnosis, and treatment of hyperthyroidism-induced autoimmune myocarditis. Additionally, we emphasize the importance of CMRI and GC therapy in the diagnosis and treatment of hyperthyroidism-related myocarditis.
甲状腺功能亢进症相关心肌损伤的表现多种多样，包括心律失常、扩张型心肌病、瓣膜疾病，甚至心源性休克。少数研究报道过甲状腺毒症诱发的急性心肌炎。然而，对其患病率及潜在机制的关注严重不足。其长期危害常被忽视，最终可能发展为扩张型心肌病和心力衰竭。我们报告1例Graves病患者，在停用抗甲状腺药物几天后，超敏心肌肌钙蛋白I呈进行性升高。心脏磁共振成像（CMRI）显示部分心肌细胞存在炎性水肿（T2加权成像下呈条索状强化信号），心外膜下壁和下壁有心肌坏死（T1加权延迟钆增强成像下呈散在强化信号），左心室收缩功能降低（48%），这提示存在甲状腺毒症诱发急性心肌炎的可能。随后给予该患者短期糖皮质激素（GC）治疗，取得了良好疗效。受此病例启发，我们旨在系统阐述甲状腺功能亢进症诱发的自身免疫性心肌炎的发病机制、诊断及治疗。此外，我们强调CMRI及GC治疗在甲状腺功能亢进症相关心肌炎诊断和治疗中的重要性。
