Yamazaki Daichi, Osaki Yoshinori, Suzuki Hiroaki, Shimano Hitoshi
Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan
Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan.
BMJ Case Rep. 2023 Mar 14;16(3):e250540. doi: 10.1136/bcr-2022-250540.
We report a rare case of takotsubo cardiomyopathy caused by subacute thyroiditis in a man in his 50s. He went to the doctor with complaints of loss of appetite, diarrhoea, chills and general malaise. He had consciousness disturbance, thyrotoxicosis and thyroid-stimulating hormone (TSH) suppression. Thyroglobulin and C reactive protein levels in the blood were elevated, but TSH receptor antibody, thyroid-stimulating antibody, antithyroglobulin antibody and antithyroid peroxidase antibody were not. We began treatment with prednisolone and propranolol after he was diagnosed with thyroid storm caused by subacute thyroiditis. The ECG revealed inverted T waves on the fifth day after admission. He was newly diagnosed with takotsubo cardiomyopathy on the day. A large thrombus was detected in the left ventricle, requiring anticoagulation therapy. Thus, even if there are no findings of takotsubo cardiomyopathy or thrombus at the onset of thyroid storm, appropriate monitoring is required because they can develop during the treatment course.
我们报告了一例50多岁男性因亚急性甲状腺炎引发的罕见的应激性心肌病病例。他因食欲不振、腹泻、寒战和全身不适前去就医。他存在意识障碍、甲状腺毒症以及促甲状腺激素（TSH）抑制。血液中的甲状腺球蛋白和C反应蛋白水平升高，但促甲状腺激素受体抗体、促甲状腺素抗体、抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体未升高。在他被诊断为亚急性甲状腺炎引发的甲状腺风暴后，我们开始使用泼尼松龙和普萘洛尔进行治疗。入院第五天心电图显示T波倒置。当天他被新诊断为应激性心肌病。在左心室检测到一个大血栓，需要进行抗凝治疗。因此，即使在甲状腺风暴发作时没有应激性心肌病或血栓的表现，也需要进行适当监测，因为它们可能在治疗过程中出现。
