Department of Cardiology, Region Hospital West Jutland, Herning, Denmark.
Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark.
Endocrine. 2022 Dec;78(3):418-428. doi: 10.1007/s12020-022-03174-w. Epub 2022 Aug 26.
This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic work-up, treatment, and outcome.
We searched PubMed and Embase databases from inception to the 17th of February 2022 for case reports or series reporting the above-mentioned association. We extracted data on demographic characteristics, clinical features, diagnostic work-up, treatment, and clinical outcomes. Cases were stratified into groups based on the presumed cause of the thyrotoxicosis (iatrogenic vs non-iatrogenic and Graves' diseases vs non-Graves' disease, respectively).
We identified 25 cases from 24 articles. The mean age was 61.7 years (+/- SD 14.5). Most patients were women (88%). Graves' disease (52%) was the leading cause of thyrotoxicosis. Previous cancer was significantly more common in patients with iatrogenic thyrotoxicosis (P = 0.03). The most common symptoms were respiratory symptoms (68%), chest pain (56%), and palpitations (40%). The most common ECG characteristics were T-wave abnormalities (48%) and ST-elevations (36%). Elevated troponin levels were found in 92% of the cases. Patients with Graves's disease and Takutsubo Syndrome had higher plasma levels of serum thyroxine (P = 0.03) and were more often treated with beta-blockers (P = 0.01) compared to patients with thyrotoxicosis of other origins. Notably, 40% of cases experienced in-hospital complications. No deaths were reported. All patients had improved cardiac function within a median follow-up of 42 days.
Evidence-based on current case reports suggests an increased risk of Takutsubo Syndrome and subsequently increased risk of in-hospital complications in patients with thyrotoxicosis.
本研究旨在通过描述临床特征、诊断方法、治疗和结局，回顾所有关于甲状腺毒症与 Takutsubo 综合征之间关联的已发表病例。
我们检索了从建库至 2022 年 2 月 17 日的 PubMed 和 Embase 数据库，以获取报告上述关联的病例报告或系列研究。我们提取了人口统计学特征、临床特征、诊断方法、治疗和临床结局的数据。根据甲状腺毒症的推测病因（医源性与非医源性、Graves 病与非 Graves 病）将病例分层。
我们从 24 篇文章中确定了 25 例病例。平均年龄为 61.7 岁（+/-标准差 14.5）。大多数患者为女性（88%）。Graves 病（52%）是导致甲状腺毒症的主要原因。医源性甲状腺毒症患者中，既往癌症更为常见（P=0.03）。最常见的症状是呼吸症状（68%）、胸痛（56%）和心悸（40%）。最常见的心电图特征是 T 波异常（48%）和 ST 段抬高（36%）。92%的病例发现肌钙蛋白水平升高。Graves 病和 Takutsubo 综合征患者的血清甲状腺素水平更高（P=0.03），并且更常使用β受体阻滞剂治疗（P=0.01），与其他原因引起的甲状腺毒症患者相比。值得注意的是，40%的病例发生院内并发症。无死亡报告。所有患者在中位数为 42 天的随访期间心功能均得到改善。
基于目前的病例报告证据表明，甲状腺毒症患者发生 Takutsubo 综合征和随后院内并发症的风险增加。
