急性心包炎是一种常见的炎症性疾病,有多种原因,包括感染,恶性肿瘤,急性心肌梗死,和自身免疫性疾病。急性心包炎很少出现在甲状腺毒症的背景下。一名65岁的有艾滋病毒病史的男子,舒张功能障碍,糖尿病前期表现为位置性胸痛,呼吸窘迫,和改变的心理。他被发现在昏昏欲睡的状态下躺在地上,通常是在演讲前五天见到他的最后一次。在介绍时,他有心动过速和心跳过速,需要使用非呼吸面罩补充氧合以保持足够的氧饱和度。初始心电图(EKG)显示弥漫性ST段抬高,早期复极,符合急性心包炎.实验室诊断显示乳酸升高,白细胞增多,急性肾损伤,检测不到促甲状腺激素,T3、T4、C反应蛋白升高,脑钠肽,和肌酐激酶。鉴于患者的复杂表现包括甲状腺毒症和心包炎,进行了涉及重症监护的多学科小组讨论,心脏病学,和内分泌学。他开始静脉注射甲基强的松龙(随后过渡到泼尼松),甲氧咪唑,还有美托洛尔.随后加入秋水仙碱治疗心包炎,并继续使用泼尼松(合并甲状腺疾病),并计划逐渐减少它们。根据心脏病学和内分泌学建议。经胸超声心动图显示有少量心包积液。考虑到发生出血性心包积液的潜在风险,未开始抗凝治疗。甲状腺超声检查不提示Graves病。甲状腺毒症可能会出现一系列症状,包括急性心包炎.EKG和超声心动图的及时识别可以帮助及时管理。
Acute pericarditis is a common inflammatory disorder with several causes including infection, malignancy, acute myocardial infarction, and autoimmune disease. Acute pericarditis can rarely present in the setting of thyrotoxicosis. A 65-year-old man with a past medical history of HIV, diastolic dysfunction, and prediabetes presented with positional chest pain, respiratory distress, and altered mentation. He was found down on the ground in a lethargic state and was last seen normally five days before the presentation. On presentation, he was tachycardic and tachypneic, requiring supplemental oxygenation with a nonrebreather mask to maintain adequate oxygen saturation. Initial electrocardiogram (EKG) demonstrated diffuse ST-elevations with early repolarization, consistent with acute pericarditis. Laboratory diagnostics revealed elevated lactic acid, leukocytosis, acute kidney injury, undetectable thyroid stimulating hormone, and elevations in T3, T4, C-reactive protein, brain natriuretic peptide, and creatinine kinase. Given the patient\'s complex presentation involving thyrotoxicosis and pericarditis, a multidisciplinary team discussion was pursued involving critical care, cardiology, and endocrinology. He was started on intravenous methylprednisolone (subsequently transitioned to prednisone), methimazole, and metoprolol. Colchicine was subsequently added for the management of pericarditis and prednisone was continued (given concomitant thyroid disease) with a plan for tapering them off, per cardiology and endocrinology recommendations. A transthoracic echocardiogram revealed a small pericardial effusion. Anticoagulation was not initiated given the potential risk of developing a hemorrhagic pericardial effusion. Thyroid ultrasound was nonsuggestive of Graves\' disease. Thyrotoxicosis may present with a constellation of symptoms, including acute pericarditis. Timely recognition with EKG and echocardiography can aid in prompt management.