【摘要】：目的：探討繼發(fā)性甲狀腺機能減退引起的心力衰竭的臨床特點及診治。方法：分析一例繼發(fā)性甲狀腺機能減退致心力衰竭患者的病例資料并文獻復(fù)習(xí)。設(shè)計：病例報告。病例：患者因心力衰竭入院,入院后心臟彩超提示全心心肌肥大,甲狀腺功能異常、腎上腺皮質(zhì)節(jié)律紊亂,血壓持續(xù)偏低、心率偏快。干預(yù)：利尿治療心力衰竭的同時,給予補充左旋甲狀腺素治療,監(jiān)測患者心率、血壓,多次復(fù)查后加用糖皮質(zhì)激素補充治療。結(jié)果：患者胸悶、氣短較前明顯好轉(zhuǎn),雙下肢再無水腫,腎功能及心功能指標較前好轉(zhuǎn),心影較前縮小(胸片),室間隔、左室游離壁厚度較前變薄(心臟彩超)。結(jié)論：同原發(fā)性甲狀腺機能減退一樣,繼發(fā)性甲狀腺機能減退也可造成一系列的心臟結(jié)構(gòu)、功能改變。激素代替治療后可逆轉(zhuǎn)心肌肥厚,心功能改善。繼發(fā)性甲減的病人通常合并其他激素的缺失,當中腎上腺皮質(zhì)激素的缺乏較為常見。在使用甲狀腺素替代治療繼發(fā)性甲減時,需監(jiān)測是否存在其他激素缺失,注意及時補充皮質(zhì)激素。因繼發(fā)性甲減的TSH水平變化不明顯,可出現(xiàn)下降、輕度升高或者正常,故臨床中極易被忽視,造成誤診、漏診。
[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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R581.2

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