Congestive Heart Failure Complicated with Chylothorax as the Manifestation in a Patient with Thyrotoxicosis: A Case Report

甲狀腺亢進以鬱血性心衰竭及乳麋胸為臨床表徵：－病例報告

原博榮(Po-Jung Yuan) ； 黃維健(Wai-Kin Wong)

《內科學誌》 22卷1期 (2011/02) Pp. 57-62

https://doi.org/10.6314/JIMT.2011.22(1).07

摘要

雖然甲狀腺亢進並不少見，但是以鬱血性心衰竭爲臨床表徵的甲狀腺亢進並不常見。在甲狀腺亢進患者中，同時存在鬱血性心衰竭和乳糜胸的情形更是罕見。一位原本健康的37歲男性病人，3年前因心搏過速，體重減輕而被診斷爲葛雷夫氏症。因爲他的臨床病情改善，所以他並不嚴格遵從甲狀腺亢進的治療。入院時，他表現出鬱血性心衰竭的症狀以及雙邊胸腔積液的情形。胸液抽吸發現高三酸甘油酯的胸腔積液，符合乳糜胸診斷。篩檢一般鬱血性心衰竭以及乳糜胸的常見原因，也都沒有進一步的發現。在此同時唯一可以找到的疾病是甲狀腺亢進。最後，鬱血性心衰竭和乳糜胸的根本原因被歸因是由於甲狀腺亢進所造成。治療甲狀腺亢進和鬱血性心衰竭後，有顯著的臨床狀況改善，包括心臟功能的恢復和乳糜胸的消失。據我們所知，在文獻中只有兩個成年病例因甲狀腺亢進而呈現出鬱血性心衰竭和乳糜胸的情形。

並列摘要

Although thyrotoxicosis is not rare, congestive heart failure as the manifestation of thyrotoxicosis is relatively uncommon. Coexistence of congestive heart failure and chylothorax is even rarer in hyperthyroid patients. A 37-year-old male patient had been well until 3 years ago when tachycardia and body weight loss developed and a diagnosis of Graves' disease was made. Due to an improvement in the patient's clinical condition, there was non-adherence to his antithyroid therapy. On admission, he presented with symptomatic congestive heart failure and bilateral pleural effusion. Thoracocentesis revealed a high triglyceride level in the pleural effusion, consistent with chylothorax. Survey for other common causes of congestive heart failure and chylothorax was negative. The only concurrent illness identified was thyrotoxicosis and the underlying cause of congestive heart failure and chylothorax was finally determined to be hyperthyroidism. Treatment of heart failure and hyperthyroid state led to a remarkable improvement in the clinical status including recovery of heart function and disappearance of chylothorax. To the best of our knowledge, there were only two adult cases in the literature presenting with congestive heart failure and chylothorax resulting from hyperthyroidism.

並列關鍵字

Thyrotoxicosis ； Congestive heart failure ； Chylothorax ； Graves' disease