以四肢无力为首发症状的甲状腺功能减退症3例并文献复习

目的探讨以四肢无力为首发症状的甲状腺功能减退症(简称甲减)患者的临床特点及治疗方法。方法回顾性分析3例以四肢无力为首发症状的甲减患者的临床资料,结合国内外文献进行讨论。结果 3例患者均以四肢无力为首发症状,主要表现为近端肌无力;实验室检查提示甲状腺激素水平减低,肌酶显著升高,可伴肾功能损害、贫血、高脂血症等表现;经甲状腺激素替代治疗,预后良好。结论甲减可以以四肢无力为首发表现,对于表现为肌无力、肌酶显著升高的患者应常规筛查甲状腺功能,其治疗以补充甲状腺激素为主。     

甲状腺机能减退性心脏病

甲状腺机能减退(下称甲减)对心血管系统的影响,尚未引起人们足够的重视。据报道,甲减性心脏病的发生率约为73%,部分病人可以心脏损害为首发症状。现将甲减所致的心脏损害归纳如下。1.甲减性心肌心包炎:最典型,且常见。主要表现为窦性心率缓慢,心脏扩大,心音低钝,心尖搏动不明显。心包积液可与心肌病并存,也可独立存在。甲减时,甲状腺激素分泌不足,可使心肌的许多酶活性降低,心肌对儿茶酚胺的敏感性降低或     

原发性甲状腺机能减退性心包积液15例分析

本文对15例原发性甲状腺机能减退(甲减)性心包积液患者的临床资料进行统计分析.结果显示女性占93.3%,无一例出现心包填塞征,二维超声心动图与心电图有多种不同的改变,血胆固醇升高,血总蛋白正常,血沉增快.对心包积液量与血T_3、T_4作相关性检测无显著相关(r≈0.125,P>0.05).进而讨论了原发性甲减性心包积液的发病机理与治疗原则.     

原发性甲状腺功能减退患者左旋甲状腺素治疗后心肌酶学的变化

原发性甲状腺功能减退症（甲减）多数起病隐匿，70％～80％患者有心血管系统表现，极易漏诊、误诊。近年来陆续有甲减患者心肌酶增高的报道。本文观察了青海地区36例原发性甲减患者在左甲状腺激素替代治疗后心肌酶学的变化。     

原发性甲状腺功能减退性心包积液与甲状腺功能、心肌酶、胆固醇的关系

目的探讨原发性甲状腺功能减退性心包积液与甲状腺功能、心肌酶、总胆固醇的关系。方法回顾性分析90例原发性甲状腺功能减退症合并心包积液患者,进行甲状腺功能、心肌酶、总胆固醇的调查,并按有无心包积液分为2组进行比较。结果 (1)两组患者在年龄、性别构成、病程、病因上差异无统计学意义。(2)甲状腺功能减退伴心包积液组患者TT3、TT4、FT3、FT4均较无心包积液组低[(0.66±0.48)nmol/L比(1.20±0.57)nmol/L,(14.64±24.46)nmol/L比(62.22±50.67)nmol/L,(2.11±0.74)pmol/L比(3.66±2.02)pmol/L,(3.12±4.49)pmol/L比(6.37±4.78)pmol/L],而TSH较无心包积液组高[(68.85±32.05)mU/L比(46.47±39.44)mU/L,均为P<0.05]。(3)心包积液组心肌酶谱、胆固醇均较无心包积液组高(P<0.05)。(4)偏相关分析提示心包积液与TT3、TT4、FT3、FT4、TSH相关(r=-0.400,-0.467,-0.368,-0.340,0.284;均为P<0.05)。结论原发性甲状腺功能减退性心包积液与甲状腺功能严重程度有关,与年龄、病程、病因无关,同时多伴有胆固醇及心肌酶谱升高。     

甲状腺机能减退症并心包积液13例临床分析

对13例甲状腺机能减退症(以下简称甲减)合并心包积液患者的分析表明,桥本甲状腺炎是甲减的常见病因(占69.2%),女占69.2%。以水肿、怕冷、声嘶、头发稀疏、眉毛脱落等为主要临床表现,血清TT30.77nmol/L,TT438.61nmol/L,TSH20u Iu/ml,UCG及X线检查示心包积液,甲状腺片替代治疗3~9个月,临床症状改善,心包积液吸收。说明甲状腺片可用以治疗甲减并心包积液。     

血液病与心血管疾病的关系

血液病与心血管系统存在着密切的联系,一方面某些血液病可引起心血管系统某些病理改变;另一方面,某些心血管病常常引起血液学的异常改变。以下分二个方面阐述。一、血液病的心血管系统表现众所周知,血液病常因贫血、出血、溶血、感染以及血液恶性病细胞浸润心血管系统,而导致心血管系统疾病的症状和体征。血液病的发病初期,从临床     

以心肌酶显著增高为主的甲减性心脏病一例和文献回顾

甲减临床表现复杂,可引起甲减性心脏病、心肌酶增高,尤以肌酸激酶(CK)增高为主,易误诊为冠心病、心肌梗死。可能与甲状腺激素减少、黏蛋白和黏多糖沉积引起心肌黏液水肿有关。故血脂、CK异常增高而其余心肌酶无明显变化者应考虑甲减性心脏病,及时行甲状腺功能测定,以免误诊漏诊。     

甲状腺素对原发性甲减患者心肌酶谱、血脂的影响

原发性甲状腺功能减退症(甲减)是由于各种原因造成甲状腺合成、分泌甲状腺激素缺乏,机体的代谢和身体的各个系统功能减退,而引起的临床综合征.近年来陆续有原发性甲减患者心肌酶谱增高的个案报道~([1,2]),亦有研究~([3])显示甲减时血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平增高,但对原发性甲减患者心肌酶谱、血脂水平的升高及甲状腺素治疗后对其动态影响缺乏系统性的研究资料.     

心包穿刺留置中心静脉导管引流心包积液

目的　探讨采用心包穿刺留置中心静脉导管引流心包积液的方法、引流液量控制和引流的体位。方法　患者半坐位或平卧位 ,根据超声心动图定位的穿刺点、穿刺深度及方向 ,1 6例采用剑突下进针 ,36例采取左侧胸壁进针 ,将中心静脉导管置入心包腔内 ,连接无菌引流袋引流心包积液。结果　 52例心包积液患者心包穿刺均获得成功 ,无明显并发症 ,52例患者引流管平均留置时间 1 4 .68± 4.66(8～ 48) d,平均引流量为 790±2 78(32 0～ 2 90 0 ) ml,心包穿刺引流后 ,心包填塞症状缓解或消失 ,心率显著减慢、收缩压和平均压明显升高 (P<0 .0 5)。结论　采用超声心动图定位 ,床边行心包穿刺 ,置入中心静脉导管引流中等量和大量心包积液安全可靠 ,引流彻底 ,疗效可靠 ,无明显并发症。     

Severe ascites with hypothyroidism and elevated CA125 concentration: a case report

Ascites caused by hypothyroidism is rare and the pathogenesis is unclear. Several reports have presented cases of progressive ascites with hypothyroidism and elevated tumor markers. We report a 31-year-old female case with massive ascites and elevated serum CA 125 concentrations. The patient had no typical feature of hypothyroidism except an accumulation of ascitic fluid which showed elevated total protein concentration and a high serum-ascites albumin gradient (SAAG). There was no finding of malignancy. Following thyroid hormone replacement, the ascites was completely resolved accompanied by reduced concentrations of serum CA125. In general, primary hypothyroidism with ascites presents with coexisting massive pericardial or pleural effusion. The massive ascites and increased serum CA125 concentrations may have led us to make the incorrect diagnosis of ovarian malignancy. The evaluation of thyroid function is useful to determine the pathology of high-protein ascites or elevated tumor markers, and ascites may be treatable by thyroid replacement therapy.     

Pericardial effusion as an expression of thyrotoxicosis

Patients who have either hyperthyroidism or hypothyroidism can present with cardiovascular complications. These manifestations of thyroid disease-congestive heart failure, atrial tachyarrhythmias, atrioventricular conduction disorders, and mitral valve dysfunction-are well known to the clinician. Pericardial effusion is considered a complication of hypothyroidism; as an expression of thyrotoxicosis, it is extremely rare.Herein, we present the case of a 76-year-old woman who had pericardial effusion associated with thyrotoxicosis. She was treated with high-dose beta-blockers, methimazole, diuretics, and short-term steroids. She recovered completely, which precluded the need for pericardiocentesis. We suggest that thyrotoxicosis be considered in the differential diagnosis of pericardial effusion.     

Transient elevation of serum tumor markers in a patient with hypothyroidism

We report a case of a 66-year-old woman admitted to our hospital for examination and treatment of uterine and rectal prolapse, pleural and pericardial effusion, and ascites. On further examination, she was diagnosed with hypothyroidism. Test results showed markedly elevated concentrations of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA 125). We consequently performed multiple imaging studies, none of which detected a malignancy. Hormonal replacement therapy with levothyroxine was started, and the pleural and pericardial effusion and ascites gradually abated. Concentrations of serum CEA and CA125 also decreased gradually after therapy with levothyroxine. These findings indicate that in patients with hypothyroidism, elevated CEA and CA125 levels do not necessarily indicate malignancy. Conversely, in any patient with elevated serum CEA and/or CA125, hypothyroidism should be considered in the differential diagnosis.     

Massive pericardial effusion secondary to Hashimoto's disease

Although relatively rare, hypothyroidism remains a significant cause of moderate to severe pericardial effusion. Pericardial effusion secondary to hypothyroidism does not usually cause symptoms since it tends to regress slowly and ultimately disappear several months after the patient has reverted to the euthyroid state. Thus, hypothyroidism must be ruled out in patients with an unexplained pericardial effusion, both to improve prognosis and to avoid unnecessary pericardiocentesis. Even when they have a massive pericardial effusion, patients should receive the standard treatment for hypothyroidism. We herein describe a 79-year-old woman with a massive pericardial effusion associated with hypothyroidism who showed a good response to standard levothyroxine replacement therapy after 5months.     

Pericardial effusion associated with subclinical hypothyroidism

Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Subclinical hypothyroidism is defined by elevated serum levels of TSH with normal levels of free thyroid hormones. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. It has been reported that sub-clinical hypothyroidism is associated with both, a significant risk of coronary heart disease at baseline and at follow-up and that mortality from cardiovascular causes is significantly higher at follow-up. However subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications. Pericardial effusion can be present in systemic disorders including hypothyroidism. We present a case of subclinical hypothyroidism in a 41-year-old Italian woman with an ubiquitary pericardial effusion. Also this case focuses attention on subclinical hypothyroidism.     

Endoscopic pericardial fenestration for a patient with sustained lupus pericarditis.

A 57-year-old woman was diagnosed in January 1982 with SLE based on ANA 1:640, positive LE cell preparation, proteinuria (3+), and pericarditis. In 1984, 1994, and 1997, the pericardial effusion was noted to have increased without signs of disease exacerbation or cardiac tamponade, and pericardial drainage was repeated to control the effusion. A massive pericardial effusion developed in August 1997. After tuberculosis, hypothyroidism, neoplasm, and progression of SLE were ruled out, we decided to perform pericardial fenestration. A safe and minimally invasive pericardial fenestration was successfully completed endoscopically. Pathologic study of the specimen revealed chronic pericarditis. We consider endoscopic pericardial fenestration to be useful for at risk patients with pericarditis to control the effusion and establish a differential diagnosis.     

甲状腺功能减退症合并心包积液的临床分析

目的 对甲状腺功能减退症（甲减）合并心包积液进行临床分析加以探讨,以使治疗工作中减少误诊、漏诊、提高治愈率。方法 诊断明确基础上用甲状腺素片治疗,初始用小剂量,每日15～30mg,逐增每日40～120mg,维持量40～80mg。结果 4～8周治疗,甲状症状明显改善,ECG恢复正常,X线及心动超声亦恢复正常,T3、T4、TSH恢复正常或明显好转。结论 遇到原因不明心包积液而心包填塞症状不明显,同时伴有或不伴有心动过缓均应想到甲减的可能,甲减性心包液不应行常规心包穿刺抽液,应早期强心利尿,使用尿状腺素片治疗,心包积液即可消失。     

Pericardial Effusion in the Emergency Department

We report the first child presenting to the emergency department with undiagnosed myxedema in whom incidental detection of pericardial effusion led to diagnosis. Moreover, this patient presented with the highest serum thyrotropin concentration reported to date, a phenomenon that caused the hook effect during laboratory analysis. We discuss key elements of the recognition and management of hypothyroidism in the pediatric population and emphasize the importance of annual screening for hypothyroidism in all patients with Down syndrome.     

Prolonged persistence of a large pericardial effusion and hemodynamic evidence of cardiac tamponade during treatment of myxedema

We describe clinical, echocardiographic, and catheterization findings that were present initially and during therapy in a myxedematous patient with a large pericardial effusion and tamponade. Treatment with thyroxine resulted in a marked improvement of most of the clinical features of hypothyroidism and some improvement in cardiac function. However, the pericardial effusion as well as clinical and laboratory evidence of tamponade persisted for 2 months after full replacement doses of T4 had been achieved. The tamponade was finally relieved by fenestration of the parietal pericardium. These findings are consistent with evidence of an abnormality of pericardial drainage that persists for months after other thyroid hormone dependent functions are normalized by thyroxine replacement. Therefore prompt surgical drainage rather than dependence on medical therapy alone is indicated in myxedematous patients who have cardiac tamponade.     

Recognition and management of cardiovascular disease related to thyroid dysfunction

Hypothyroidism and hyperthyroidism are both associated with clinically significant cardiovascular derangements. In hypothyroidism, these include pericardial effusion, heart failure, and the complex interrelationship between hypothyroidism and ischemic heart disease. Cardiovascular disorders associated with hyperthyroidism include atrial tachyarrhythmias, mitral valve dysfunction, and heart failure. Although these usually occur in individuals with intrinsic heart disease, thyroid dysfunction alone rarely causes serious but reversible cardiovascular dysfunction. Patients with commonly encountered cardiac disorders, e.g., idiopathic cardiomyopathy and atrial fibrillation, should be screened for potentially contributing subclinical thyroid diseases. In patients with heart failure and hypothyroidism, initial management should focus on diagnosis and optimal management of any primary cardiac disease, whereas in hyperthyroidism, aggressive measures to control excess thyroid hormone action should generally have the highest priority.