心力衰竭和心肌病的发展已被确定为甲状腺毒症或甲状腺风暴的罕见但危及生命的并发症。甲状腺毒症引起的心肌病和心源性休克已被证明是成人猝死的主要原因之一。然而,非心脏选择性β受体阻滞剂治疗甲状腺毒症与严重失代偿,甚至心源性休克的发生有关,如果心脏功能未知,通常需要多学科护理团队来解决.这里,我们报道了一例63岁男性,既往有甲状腺功能亢进症病史,因持续呼吸急促被送往急诊室.生命体征明显为低血压,伴有不规则心跳的心动过速,心电图提示房颤伴快速心室率。甲状腺功能检查对TSH严重抑制有显著意义,Burch-Wartofsky得分>45.患者在静脉注射美托洛尔后不久迅速失代偿,随后需要插管和加压支持。之后进行的二维(2D)超声心动图(或回声)对于四腔扩张,轻度整体运动功能减退和左心室射血分数降低具有重要意义。内分泌学,心脏病学,并咨询了肺重症监护团队以协助进行多模式管理。在失代偿性心力衰竭中使用非心脏选择性β受体阻滞剂被认为是迅速恶化的原因。通过多模态管理方法,患者随后好转,并最终随着甲状腺风暴和心源性休克的解决而出院,并与初级保健提供者密切随访,内分泌学家,和心脏病专家。此案例说明了多学科团队方法在甲状腺毒症引起的心源性休克的急性治疗中的重要性。团队的建议有助于患者从疾病的急性期恢复。此外,这个案例进一步强调了评估心脏功能的重要性,优选在患者开始使用β受体阻滞剂之前进行回声。
The development of heart failure and cardiomyopathy has been identified as an infrequent but life-threatening complication of thyrotoxicosis or thyroid storm. Thyrotoxicosis-induced cardiomyopathy and cardiogenic shock have been shown to be one of the major causes of sudden mortality in adults. However, the treatment of thyrotoxicosis with non-cardioselective beta-blockers has been implicated in the development of severe decompensation and even cardiogenic shock if cardiac function is not known and often requires a multidisciplinary care team to address it. Here, we have reported the case of a 63-year-old male with a past medical history of hyperthyroidism who presented to the emergency room with persistent shortness of breath. Vital signs were notable for hypotension, tachycardia with an irregular heartbeat, with ECG suggestive of atrial fibrillation with a rapid ventricular rate. The thyroid function test was significant for severely suppressed TSH, and the Burch-Wartofsky Score was >45. The patient rapidly decompensated shortly after being given IV metoprolol, subsequently requiring intubation and pressor support. Two-dimensional (2D) echocardiography (or echo) done afterward was significant for four-chamber dilation with mild global hypokinesis and reduced left ventricular ejection fraction. Endocrinology, Cardiology, and Pulmonary Critical Care teams were consulted to assist in multi-modality management. The administration of a non-cardioselective beta-blocker in decompensated heart failure was suggested as the cause of the rapid deterioration. Through a multi-modality management approach, the patient subsequently improved and was eventually discharged with the resolution of thyroid storm and cardiogenic shock, and with close follow-up with the primary care provider, endocrinologist, and cardiologist. This case illustrates the significance of a multidisciplinary team approach in the acute management of thyrotoxicosis-induced cardiogenic shock, as recommendations from the team were instrumental in helping the patient recover from the acute phase of the illness. Also, this case further highlights the significance of assessing the cardiac function, preferably performing echo before starting the patient on beta-blockers.