Toxic Multinodular Goitre (Thyrotoxicosis with Hyperthyroidism) Induced Cardiomyopathy: A Case Report  

作　　者：Sahil N. Fulara Nasir Y. Fulara 

机构地区：[1]Department of Medicine, Jaslok Hospital and Medical Research Center, Mumbai, India

出　　处：《Open Journal of Clinical Diagnostics》2017年第2期67-72,共6页临床诊断学期刊（英文）

摘　　要：Introduction: Toxic multinodular goitre, first described by H.S. Plummer in 1913, is unremitting and often develops slowly, with more subtle symptoms than Graves’ disease. Cardiac symptoms such as tachycardia, heart failure, or arrhythmia and atrial fibrillation are most frequent. Here we describe a case who presented with symptoms of thyroid enlargement and heart failure. Case report: A 48-year old female presented to us with complaints of dysphagia, hoarseness of voice, breathlessness on exertion and palpitations since one month ago. Furthermore, the patient gave history of swelling of the neck which was initially pea sized and gradually increased to the current size over a period of two months. On examining the swelling of the neck, thyroid gland appears enlarged, firm with multiple nodules. Two-dimensional echocardiography revealed a dilated left ventricle with generalized hypokinesia. Computed Tomography of the neck suggested enlarged thyroid gland (12.1 cm × 6.5 cm) with heterogenous architecture, and thyroid gland encircling the trachea for approximately 270 degree with mass effect. Thyroid scan showed multinodular goitre with multiple hyperfunctioning nodules of both lobes and warm nodules only in left lobe. The patient was diagnosed as multinodular goitre with cardiomyopathy. The patient was treated medically with methimazole, propranolol, aspirin, ramipril, sustained release urodeoxycholic acid, rosuvastatin, pantoprazole and multivitamin. The patient underwent near total thyroidectomy with radioactive iodine ablation, as and when required. Conclusion: Patients with toxic multinodular goitre very frequently present with cardiovascular symptoms, which when identified and treated early can reduce the morbidity significantly.Introduction: Toxic multinodular goitre, first described by H.S. Plummer in 1913, is unremitting and often develops slowly, with more subtle symptoms than Graves’ disease. Cardiac symptoms such as tachycardia, heart failure, or arrhythmia and atrial fibrillation are most frequent. Here we describe a case who presented with symptoms of thyroid enlargement and heart failure. Case report: A 48-year old female presented to us with complaints of dysphagia, hoarseness of voice, breathlessness on exertion and palpitations since one month ago. Furthermore, the patient gave history of swelling of the neck which was initially pea sized and gradually increased to the current size over a period of two months. On examining the swelling of the neck, thyroid gland appears enlarged, firm with multiple nodules. Two-dimensional echocardiography revealed a dilated left ventricle with generalized hypokinesia. Computed Tomography of the neck suggested enlarged thyroid gland (12.1 cm × 6.5 cm) with heterogenous architecture, and thyroid gland encircling the trachea for approximately 270 degree with mass effect. Thyroid scan showed multinodular goitre with multiple hyperfunctioning nodules of both lobes and warm nodules only in left lobe. The patient was diagnosed as multinodular goitre with cardiomyopathy. The patient was treated medically with methimazole, propranolol, aspirin, ramipril, sustained release urodeoxycholic acid, rosuvastatin, pantoprazole and multivitamin. The patient underwent near total thyroidectomy with radioactive iodine ablation, as and when required. Conclusion: Patients with toxic multinodular goitre very frequently present with cardiovascular symptoms, which when identified and treated early can reduce the morbidity significantly.

关 键 词：CARDIOMYOPATHY DYSPHAGIA GOITRE THYROID 

分 类 号：R5[医药卫生—内科学]