亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺疾病与缺血性卒中的风险和转归

亚临床甲状腺疾病包括亚临床甲状腺功能减退和亚临床甲状腺功能亢进,以后者更常见。亚临床甲状腺疾病可能导致高血压、糖尿病、血脂异常、动脉粥样硬化、心房颤动、高同型半胱氨酸血症等血管危险因素的发生率显著增高,同时与急性缺血性卒中的转归可能有关。     

甲状腺功能亢进并发心血管疾病的研究进展

甲状腺激素在心血管系统中扮演着重要的角色,它通过基因和非基因作用,影响心肌收缩力、心率、舒张功能和全身血管阻力。即使是亚临床甲状腺功能亢进亦可引起心房颤动甚至造成血流动力学的崩溃。本文综述现阶段甲状腺功能亢进对心血管系统影响的实验室研究和临床发现。     

亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常 ,包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退等。它们可影响正常的生理及代谢过程 ,部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置     

甲状腺功能低下与亢进的脉冲多普勒诊断

目的：探讨脉冲多普勒对亚临床甲状腺功能低下和甲状腺功能亢进的鉴别诊断价值。方法：应用彩色多普勒和脉冲多普勒技术检查12例亚临床甲状腺功能低下和23例甲状腺功能亢进患者，测量双侧甲状腺上动脉的收缩期最大血流速度、舒张期末最低流速和阻力指数，用统计学方法进行分析。结果：甲状腺功能亢进患者的甲状腺上动脉各项血流动力学指标均高于亚临床甲状腺功能低下者，经t检验，2种疾病各项指标间差异均有显著意义（P＜0．01）。左、右侧甲状腺上动脉收缩期最大血流速度t值分别为3．220，2859；舒张期末最低流速t值为2．806，2．941；阻力指数为4．1923，3．273。 应用脉冲多普勒技术诊断亚临界甲状腺功能低下的准确率为83．33％；诊断甲状腺功能亢进的准确率为91．30％。结论：脉冲多普勒不便能诊断亚临界甲状腺功能低下和甲状腺功能亢进，而且是鉴别此2种疾病的可靠方法。     

环球要刊巡览

<正>亚临床甲状腺功能异常与高血压无相关性南京医科大学附属一院的Duan等在江苏省六个地区6992名居民中开展了一项横断面研究,调查中国亚临床甲状腺功能异常与高血压的关系。共收集6583例资料(女性4115例,男性2468例),分为甲状腺功能正常(5669例,86.11%),亚临床甲状腺功能亢进(108例,1.65%)和亚临床甲状腺功能减退(806例,12.24%)三组。经过校正年龄、性别、体质指数和吸烟状况,亚临床甲状腺功能减退和甲状腺功能亢进组的收缩压、舒张压和脉压与正常组没有     

亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常，包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退先进。它们可影响正常的生理及代谢过程，部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置。     

急性前循环大面积脑梗死合并甲状腺危象一例

甲状腺功能亢进是缺血性卒中的少见危险因素,其可能导致心房颤动和血管狭窄、闭塞、畸形及血液高凝状态等,从而导致脑梗死的发生.在某些诱因下,甲状腺功能亢进患者可能发生罕见且致死性的甲状腺危象,使病情更加复杂、凶险.作者报道1例40岁急性脑梗死女性患者,既往甲状腺功能亢进病史8年,血管评估显示左侧颈内动脉闭塞,血栓弹力图提示...     

Embolic risk in atrial fibrillation that arises from hyperthyroidism: review of the medical literature

Atrial fibrillation, the most common cardiac complication of hyperthyroidism, occurs in an estimated 10% to 25% of overtly hyperthyroid patients. The prevalence of atrial fibrillation increases with age in the general population and in thyrotoxic patients. Other risk factors for atrial fibrillation in thyrotoxic patients include male sex, ischemic or valvular heart disease, and congestive heart failure. The incidence of arterial embolism or stroke in thyrotoxic atrial fibrillation is less clear. There are many reports of arterial thromboembolism associated with hyperthyroidism, including cases of young adults without coexisting risk factors other than thyrotoxic atrial fibrillation. The use of anticoagulative agents to prevent thromboembolic sequelae of thyrotoxic atrial fibrillation is controversial: National organizations provide conflicting recommendations in their practice guidelines. Herein, we review the medical literature and examine the evidence behind the recommendations in order to determine the best approach to thromboembolic prophylaxis in patients who have atrial fibrillation that is associated with hyperthyroidism.     

Diagnostic algorithm for atrial fibrillation caused by occult hyperthyroidism

Occult hyperthyroidism, a subclinical thyrotoxic state, is not readily identifiable clinically or through routine thyroid function tests. "Idiopathic" atrial fibrillation may be a manifestation of occult hyperthyroidism in the elderly. A normal response on a TRH stimulation test excludes this diagnosis. A blunted TSH response, coupled with elevation of free thyroid hormones and a high radioactive iodine uptake, will settle the diagnosis. Patients with occult hyperthyroidism frequently have toxic adenomas or nonpalpable nodular goiters, and treatment is best achieved with radioactive iodine ablation.     

Atrial fibrillation associated with subclinical hyperthyroidism

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. We present a case of atrial fibrillation associated with subclinical hyperthyroidism, in a 78-year-old Italian woman. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism.     

Paroxysmal atrial fibrillation during acute myocardial infarction associated with subclinical hyperthyroidism, severe three vessels coronary artery disease and elevation of prostate-specific antigen after TURP

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. Paroxysmal atrial fibrillation is a frequent complication of acute myocardial infarction. It has been reported that subclinical hyperthyroidism is not associated with CHD or mortality from cardiovascular causes but it is sufficient to induce an increase in atrial fibrillation rate and increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. It has also been reported that serum prostate-specific antigen (PSA) decreases drastically in patients who undergo transurethral resection of the prostate(TURP). We present a case of paroxysmal atrial fibrillation during acute myocardial infarction associated with subclinical hyperthyroidism, severe three vessels coronary artery disease and elevation of PSA after TURP in a 78-year-old Italian man.     

老年人亚临床甲状腺功能亢进与心房颤动

目的观察老年人亚临床甲状腺功能亢进(甲亢)与心房颤动(房颤)发生的相关性。方法观察组43例,年龄63~82岁,为亚临床性甲亢患者,即血浆甲状腺刺激激素(TSH)<0.4μU/L,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)正常,无甲亢的临床表现;对照组50例,年龄60~85岁,甲状腺功能检查正常,即0.4μU/L相似文献   

Reversible thyrotoxic cardiomyopathy--report of three cases

Three patients with thyrotoxicosis, atrial tachyarrhythmia and congestive heart failure despite successful treatment of hyperthyroidism revealed atrial fibrillation/flagellation and left ventricular systolic dysfunction. Congestive heart failure resolved and left ventricular systolic function normalized only after successful cardioversion to sinus rhythm. In some patients treated for hyperthyroidism, achievement of euthyroid state is not by itself sufficient to reverse left ventricular failure. Improvement after successful reversion of atrial tachyarrhythmia suggest its essential role in pathogenesis of thyrotoxic cardiomyopathy.     

甲状腺功能亢进症和缺血性脑卒中

甲状腺功能亢进症(甲亢)和亚临床甲亢时房颤的发生率增加,其伴有的高凝状态也可引起心源性脑卒中的发生.此外,甲亢时可伴有急性脑静脉血栓形成、巨细胞性颞动脉炎和烟雾病等缺血性脑血管病,但缺乏相关证据.现对甲亢与脑血管疾病之间的关系作一综述,旨在探讨其共同的发病机制及临床特点,并为两者合并存在时的正确治疗提供参考.     

Paroxysmal ventricular tachycardia and paroxysmal atrial fibrillation associated with subclinical hyperthyroidism, chronic renal failure and elevation of prostate-specific antigen during acute myocardial infarction

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. Paroxysmal atrial fibrillation is a frequent complication of acute myocardial infarction. 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 an increase in atrial fibrillation rate. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Moreover chronic renal failure presents an increased arrhythmic risk. Apparently spurious result has been reported in a work about mean serum prostate-specific antigen (PSA) concentration during acute myocardial infarction with mean serum PSA concentration significantly lower on day 2 than either day 1 or day 3 and it has been reported that these preliminary results could reflect several factors, such as antiinfarctual treatment, reduced physical activity or an acute-phase response. We present a case of paroxysmal ventricular tachycardia and paroxysmal atrial fibrillation associated with subclinical hyperthyroidism, chronic renal failure and elevation of serum PSA concentration in a 90-year-old Italian man during acute myocardial infarction. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism and of chronic renal failure. Moreover, our report also confirms previous findings and extends the evaluation of PSA during acute myocardial infarction.     

Acute myocardial infarction and subclinical hyperthyroidism without significant coronary stenoses

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 CHD or mortality from cardiovascular causes but increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. It has been also reported an acute myocardial infarction with normal coronary arteries associated with iatrogenic hyperthyroidism and with a myocardial bridge too. Moreover, it has been reported that simply measuring maximum P wave duration and P wave dispersion values, may help to determine the patients with subclinical hyperthyroidism and high risk for the development of atrial fibrillation. We present a case of an acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism.     

Intermittent changing axis deviation with intermittent left anterior hemiblock during atrial flutter with subclinical hyperthyroidism

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 CHD or mortality from cardiovascular causes but it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias including atrial fibrillation and atrial flutter. Intermittent changing axis deviation during atrial fibrillation has also rarely been reported. We present a case of intermittent changing axis deviation with intermittent left anterior hemiblock in a 59-year-old Italian man with atrial flutter and subclinical hyperthyroidism. To our knowledge, this is the first report of intermittent changing axis deviation with intermittent left anterior hemiblock in a patient with atrial flutter.