继发性甲减致心力衰竭的1例病例报道及文献复习

发布时间：2019-03-05 15:35

【摘要】：目的：探讨继发性甲状腺机能减退引起的心力衰竭的临床特点及诊治。方法：分析一例继发性甲状腺机能减退致心力衰竭患者的病例资料并文献复习。设计：病例报告。病例：患者因心力衰竭入院,入院后心脏彩超提示全心心肌肥大,甲状腺功能异常、肾上腺皮质节律紊乱,血压持续偏低、心率偏快。干预：利尿治疗心力衰竭的同时,给予补充左旋甲状腺素治疗,监测患者心率、血压,多次复查后加用糖皮质激素补充治疗。结果：患者胸闷、气短较前明显好转,双下肢再无水肿,肾功能及心功能指标较前好转,心影较前缩小(胸片),室间隔、左室游离壁厚度较前变薄(心脏彩超)。结论：同原发性甲状腺机能减退一样,继发性甲状腺机能减退也可造成一系列的心脏结构、功能改变。激素代替治疗后可逆转心肌肥厚,心功能改善。继发性甲减的病人通常合并其他激素的缺失,当中肾上腺皮质激素的缺乏较为常见。在使用甲状腺素替代治疗继发性甲减时,需监测是否存在其他激素缺失,注意及时补充皮质激素。因继发性甲减的TSH水平变化不明显,可出现下降、轻度升高或者正常,故临床中极易被忽视,造成误诊、漏诊。
[Abstract]:Objective: to investigate the clinical features, diagnosis and treatment of heart failure caused by secondary hypothyroidism. Methods: a case of heart failure caused by secondary hypothyroidism was analyzed and the literature was reviewed. Design: case report. Cases: the patients were admitted to hospital due to heart failure. After admission, color Doppler ultrasonography showed that the whole heart was hypertrophic, thyroid function was abnormal, adrenocortical rhythm was disturbed, blood pressure was low and heart rate was faster. Intervention: when diuresis was used to treat heart failure, levothyroxine was given to monitor the heart rate and blood pressure of the patients. After repeated reexamination, the patients were supplemented with glucocorticoid. Results: chest tightness, shortness of breath, no swelling of lower limbs, improvement of renal function and cardiac function, reduction of heart shadow (chest film), thickness of ventricular septum and left ventricular free wall (heart color Doppler) were found in the patients. Conclusion: as with primary hypothyroidism, secondary hypothyroidism can cause a series of cardiac structural and functional changes. Hormone replacement therapy can reverse cardiac hypertrophy and improve cardiac function. Patients with secondary hypothyroidism are often associated with other hormone deletions, with corticosteroid deficiency being more common. In the use of thyroxine replacement therapy for secondary hypothyroidism, it is necessary to monitor the existence of other hormone deletions, attention to timely supplement of corticosteroids. Because the change of TSH level in secondary hypothyroidism is not obvious, it may be decreased, slightly elevated or normal, so it is easy to be ignored in clinical practice, resulting in misdiagnosis and missed diagnosis.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R581.2

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