Staffurth J S, Morrison N D
Postgrad Med J. 1968 Dec;44(518):885-90. doi: 10.1136/pgmj.44.518.885.
(1) Enlargement of the heart was found in 35% of a group of older patients with thyrotoxicosis who had no evidence of associated heart disease. Atrial fibrillation was present in 48% of patients with cardiac enlargement and in 10% with a normal sized heart. Both complications were more common when there was associated heart disease. (2) In patients with an enlarged heart but no associated heart disease a reduction in heart-size after treatment of thyrotoxicosis was observed in five of twenty-three who had sinus rhythm throughout, and in three of eleven who had atrial fibrillation on presentation with subsequent reversion to sinus rhythm. There was no reduction in heart size in ten who had persistent atrial fibrillation after completion of treatment. Reduction in heart size was most marked in patients who had presented with frank cardiac failure. (3) The incidence of cardiac enlargement and atrial fibrillation both increased with advancing age but whereas enlargement was common over 45 years atrial fibrillation was rarely seen under 55 years of age. Only one of thirteen patients with an enlarged heart under 55 years had atrial fibrillation. (4) It is concluded that enlargement of the heart may be a manifestation of thyrotoxic heart disease, that it may precede the onset of atrial fibrillation in some instances, and consequently that atrial fibrillation is not necessarily the cause of an enlarged heart in thyrotoxicosis.
（1）在一组无相关心脏病证据的老年甲状腺毒症患者中，35%发现有心脏扩大。心脏扩大的患者中48%存在房颤，心脏大小正常的患者中10%存在房颤。当伴有相关心脏病时，这两种并发症更为常见。（2）在心脏扩大但无相关心脏病的患者中，23例始终为窦性心律的患者中有5例在甲状腺毒症治疗后心脏大小减小，11例初诊时为房颤随后恢复为窦性心律的患者中有3例心脏大小减小。治疗结束后仍有持续性房颤的10例患者心脏大小未减小。心脏大小减小在出现明显心力衰竭的患者中最为明显。（3）心脏扩大和房颤的发生率均随年龄增长而增加，但心脏扩大在45岁以上常见，而房颤在55岁以下很少见。55岁以下心脏扩大的13例患者中只有1例有房颤。（4）得出的结论是，心脏扩大可能是甲状腺毒症性心脏病的一种表现，在某些情况下可能先于房颤发作，因此房颤不一定是甲状腺毒症中心脏扩大的原因。
