甲状腺功能减退相关性呼吸衰竭临床分析(附2例报告)

The clinical analysis of hypothyroidism related respiratory and heart failure(with two cases report)

目的通过对2例甲状腺功能减退(甲减)导致的呼吸或循环衰竭的临床病例报告,复习甲减导致呼吸、心力衰竭的机制等,进而提高对甲减相关性呼吸、心力衰竭的诊治水平。方法回顾性分析福建省立医院收治的2例以呼吸衰竭、心力衰竭为主要表现的2例甲减患者的临床特点,并进行相关文献回顾。结果病例1报道了患者先后两次间隔9个月均因甲减危象并发呼吸衰竭而入院诊治的过程。病例2报道了甲减患者以心力衰竭主要并发症诊治过程。结论两例均为女性患者,均因肺部感染导致急性发病,但分别以呼吸、心血管系统不同程度受累为主要表现,提示甲减首发危及生命的并发症可能跟个体心肺代偿功能,甲减发展速度、严重程度等相关。同时,甲减导致呼吸衰竭、心力衰竭是临床中少见且容易漏诊、误诊的危重症,应引起临床医师的重视。

Objective in order to improve the accurate diagnosis rate as well as the treatment in the hypothyroid related critical illness, two cases of respiratory and heart failure caused by severe hypothyroidism were emphasized and the mechanism was reviewed in the literature.Method Two typical cases of hypothyroid which respectively caused the critical injury of the respiratory and circulatory systems were extracted from fujian Provincial Hospital databases of inpatients. They were retrospectively analysed and reviewed.Resultcase 1 shows a 60-year-old woman who presented mainly as refractory respiratory failure of unknown origin in the two admissions with an interval of nine months, which finally turned out to be the complication of the underlying disease- hypothyroidism crisis. case 2 shows a 84 -year-old lady manifested as hypothyroid related heart failure. Both patients have recovered from the replacement of levothyroxine.Conclusion The respiratory and circulatory system injury triggered by pulmonary infection were separately present in the two cases of female patients. it indicates that the life-threatening complications as the first presentation of hypothyroidism are likely to be associated with the individual pulmonary and cardiac function, the developing speed of hypothyroidism and its severity. it requires clinicians to pay more attention to the critical illness and emergency state of respiratory and heart failure resulting from hypothyroidism which can be easily overlooked and misdiagnosed .