Thyrotoxic Cardiomyopathy: State of the Art.

TouchREVIEWS in endocrinology Pub Date : 2023-05-01 Epub Date: 2023-02-07 DOI:10.17925/EE.2023.19.1.78
Juan Eduardo Quiroz-Aldave, María Del Carmen Durand-Vásquez, Carlos Jhonatan Lobato-Jeri, Juan-Manuel Muñoz-Moreno, Diana Carolina Deutz Gómez Condori, Sofía Pilar Ildefonso-Najarro, Felipe Contreras-Yametti, Francisca Zavaleta-Gutiérrez, Luis Concepción-Urteaga, Marcio José Concepción-Zavaleta
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Abstract

Thyroid hormones, mainly triiodothyronine, have genomic and non-genomic effects on cardiomyocytes related to the contractile function of the heart. Thyrotoxicosis, which is the set of signs and symptoms derived from the excess of circulating thyroid hormones, leads to increased cardiac output and decreased systemic vascular resistance, increasing the volume of circulating blood and causing systolic hypertension. In addition, the shortening of the refractory period of cardiomyocytes produces sinus tachycardia and atrial fibrillation. This leads to heart failure. Approximately 1% of patients with thyrotoxicosis develop thyrotoxic cardiomyopathy, a rare but potentially fatal form of dilated cardiomyopathy. Thyrotoxic cardiomyopathy represents a diagnosis of exclusion, and prompt identification is crucial as it is a reversible cause of heart failure, and heart function can be recovered after achieving a euthyroid state using antithyroid drugs. Radioactive iodine therapy and surgery are not the best initial therapeutic approach. Moreover, it is important to manage cardiovascular symptoms, for which beta blockers are the first-line therapeutic option.

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甲亢性心肌病:最新进展
甲状腺激素,主要是三碘甲状腺原氨酸,对与心脏收缩功能有关的心肌细胞具有基因组和非基因组效应。甲亢是循环中甲状腺激素过量引起的一系列症状和体征,会导致心输出量增加,全身血管阻力降低,循环血量增加,引起收缩期高血压。此外,心肌细胞的折返期缩短会产生窦性心动过速和心房颤动。这会导致心力衰竭。约有1%的甲亢患者会发生甲亢性心肌病,这是一种罕见但可能致命的扩张型心肌病。甲亢性心肌病是一种排除性诊断,及时发现至关重要,因为它是心力衰竭的可逆性病因,在使用抗甲状腺药物达到甲状腺功能亢进状态后,心脏功能可以恢复。放射性碘治疗和手术并非最佳的初始治疗方法。此外,控制心血管症状也很重要,β受体阻滞剂是一线治疗方案。
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