以單純鬱血性心衰竭併雙側大量肺積水為表現的甲狀腺亢進－個案報告

Hyperthyroidism Presenting as Isolated Congestive Heart Failure with Bilateral Massive Pleural Effusion - A Case Report

10.29461/TGG.201805_13(2).0004

王奕淇(Wang YC)；陳勇良(Chen YL)；方姿蓉(Tzu-Jung Fang)

鬱血性心衰竭 ； 肋膜積水 ； 甲狀腺亢進 ； 肺高壓 ； Congestive heart failure ； Pleural effusion ； Pulmonary hypertension ； Hyperthyroidism

台灣老年醫學暨老年學雜誌

13卷2期（2018 / 05 / 01）

118 - 125

繁體中文

76歲女性，因鬱血性心衰竭急性發作併雙側大量肋膜積水住院治療，探究其心衰竭原因，發現為甲狀腺亢進引起，給予抗甲狀腺藥物治療後，甲狀腺功能恢復正常，經過三年門診追蹤，也未再發生心衰竭。老年甲狀腺亢進症狀往往不像年輕人典型，可能僅以心搏過速、疲倦淡漠、體重減輕做為表現，且心衰竭並非甲狀腺亢進常見之臨床症狀，即使以心衰竭作為甲狀腺亢進主要表現的病人，多數有心搏過速或心房顫動。此個案心跳速率正常，以肺高壓、鬱血性心衰竭併雙側大量肋膜積水為表現，因此當老年病患出現不明原因心衰竭，即使無心搏過速，亦建議進行甲狀腺功能檢測，以排除甲狀腺亢進。

A 76-year-old woman was admitted due to hyperthyroidism-associated congestive heart failure with acute exacerbation, complicated with bilateral massive pleural effusion. After successful antithyroid treatment, there was no more heart failure episode in a 3-year follow-up period. Congestive heart failure is not a common manifestation of hyperthyroidism. However, most of the patients presenting with congestive heart failure as the main symptom of hyperthyroidism have had sinus tachycardia or atrial fibrillation. This case, presented as isolated congestive heart failure with bilateral massive pleural effusion without tachycardia as the manifestation of hyperthyroidism, was very rare. In conclusion, if an elderly patient develops unexplained congestive heart failure, we should take hyperthyroidism into consideration even the heart rate shows normal sinus rhythm.