Haidous Mohammad, Al Armashi Abdul Rahman, Balozian Patil, Ravakhah Keyvan
Internal Medicine, St. Vincent Charity Medical Center, Cleveland, USA.
Cureus. 2022 Mar 8;14(3):e22968. doi: 10.7759/cureus.22968. eCollection 2022 Mar.
Hyperthyroidism often leads to heart failure when left untreated, specifically high output heart failure and left ventricular (LV) hypertrophy. A very minimal portion of those develop severe LV dysfunction. We report a case of a 65-year-old male who presented with signs and symptoms of heart failure and was found to have hyperthyroidism, severe systolic dysfunction, and severe dilated cardiomyopathy. The patient is a 65-year-old African American male with a history of hypertension (HTN) who presented with complaints of dyspnea on exertion and bilateral lower limb edema of one-week duration. A review of systems revealed paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, and weight loss. Physical exam showed tachycardia but otherwise no exophthalmos, no thyromegaly, no thyroid nodules, clear lungs, normal heart sounds, regular heart rhythm, normal reflexes, and 2+ edema of bilateral lower extremities up to the knees. Labs showed elevated B-natriuretic peptide, severely suppressed thyroid-stimulating hormone, elevated free triiodothyronine (FT3), and free thyroxine (FT4). Electrocardiogram (EKG) revealed sinus tachycardia, incomplete left bundle branch block, and non-specific T wave abnormality. Echocardiography revealed abnormal (LV) structure and function, with moderate to severe dilatation without LV hypertrophy, severe LV systolic dysfunction with ejection fraction (EF) 30-35%, and an abnormal LV diastolic function. The patient was managed with diuresis for acute onset heart failure and with beta-blocker and methimazole for symptomatic hyperthyroidism. Thyroid assessment is an important step in evaluating any patient with suspected heart failure. This case highlights the balance that should exist between treating hyperthyroidism symptoms and managing disease states such as acute heart failure.
甲状腺功能亢进症若不治疗，常导致心力衰竭，尤其是高输出量心力衰竭和左心室（LV）肥厚。其中只有极小一部分会发展为严重的左心室功能障碍。我们报告一例65岁男性病例，该患者出现心力衰竭的症状和体征，被发现患有甲状腺功能亢进症、严重收缩功能障碍和严重扩张型心肌病。患者为65岁非裔美国男性，有高血压（HTN）病史，主诉劳力性呼吸困难和持续一周的双侧下肢水肿。系统回顾发现阵发性夜间呼吸困难、端坐呼吸、心悸、疲劳和体重减轻。体格检查显示心动过速，但无突眼、无甲状腺肿大、无甲状腺结节、肺部清晰、心音正常、心律规整、反射正常，双侧下肢膝关节以下有2+水肿。实验室检查显示B型利钠肽升高、促甲状腺激素严重受抑制、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）升高。心电图（EKG）显示窦性心动过速、不完全性左束支传导阻滞和非特异性T波异常。超声心动图显示左心室（LV）结构和功能异常，有中度至重度扩张但无左心室肥厚，严重左心室收缩功能障碍，射血分数（EF）为30 - 35%，左心室舒张功能异常。该患者因急性心力衰竭接受利尿治疗，并因有症状的甲状腺功能亢进接受β受体阻滞剂和甲巯咪唑治疗。甲状腺评估是评估任何疑似心力衰竭患者的重要步骤。本病例突出了在治疗甲状腺功能亢进症状和管理诸如急性心力衰竭等疾病状态之间应保持的平衡。
