COMPLEX DISORDERS OF HEART RHYTHM AND CONDUCTIVITY IN A PATIENT WITH HYPOTHYROIDISM (CLINICAL OBSERVATION)

The article describes a clinical case of the occurrence of complex disorders of the heart rhythm and conductivity in a patient of 45 years with decompensated hypothyroidism. The literature data on specific cardiomyopathy appearing in patients with hypothyroidism (“hypothyroid heart”), metabolic, hemodynamic changes against the background of hypothyroidism and possible violations of heart rhythm and conductivity are given. In the described clinical case the patient’s medical history is given, who has been observed in an endocrinologist for hypothyroidism for the last 3 years. 6 months before this hospitalization patient stopped taking levothyroxine on her own initiative. She noticed deterioration in the last 3 months: the clinic of hypothyroidism appeared and began to grow, a frequent extrasystole appeared. At an objective survey — a symptomatology of the expressed hypothyroidism. A comprehensive examination of the patient was performed, which revealed atrioventricular blockade of the 1st degree, frequent ventricular extrasystole, prolongation of the QT interval on the ECG, late ventricular potentials against the background of low concentrations of sodium and potassium in the blood. During the first 24 hours of hospitalization, there was a clinical death. A clear positive dynamics was traced against the background of therapy aimed at the correction of electrolyte disorders, as well as hormone replacement therapy with levothyroxine.

1. Батчаев Э.О. Особенности поражения сердца при первичном гипотиреозе: Дисс. …канд. мед. наук. — Санкт-Петербург, 2003. Batchaev E.O. Features of heart disease in primary hypothyroidism: Diss…. Cand. of med. sciences. — Saint-Petersburg. 2003

2. Бланкова З.Н., Агеев Ф.Т., Середенина Е.М. и др. Гипотиреоз и сердечно-сосудистые заболевания. РМЖ. 2014; 13: 980. Blankova Z.N., Ageev F.T., Seredinina E.M. and others. Hypothyroidism and cardiovascular diseases. RMJ. 2014; 13: 980.

3. Петунина Н.А. Синдром гипотиреоза. РМЖ. 2005; 6: 295. Petunina N. Syndrome hypothyroidism. RMJ. 2005; 6: 295.

4. Сторожаков Г.И., Горбаченкова А.А. Руководство по кардиологии: учебное пособие в 3 т. М. 2009; 512 с. Storozhakov G.I., Gorbatchenkov A.A. Manual of cardiology: textbook in 3 vol. 2009; 512 p.

5. Drover V.A.B., Agellon L.B. Reguation of the human holesterol 7ά-hydroxylase gene (CYP7A1) by thyroid hormone in transgenic mise. Endocrinol. 2004; 145: 547–581.

6. Faure P., Oziol L., Artur Y., Chomard P. Thyroid hormone (T3) and its acetic derivative (TA3) protect low-density lipoproteins from oxidation by different mechanisms. Biochimie. 2004; 86: 411–418.

7. Napoli R., Biondi B., Guardasole V. et al. Impact of hyperthyroidism and correction on vascular reactivity in humans. Circulation. 2001; 104: 3076–3080.

8. Rodondi N., den Elzen W.P., Bauer D.C. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010; 304(12): 1365–1374.

9. Rush J. Danzi S., Klein I. Role of thyroid disease in the development of statin-induced myopathy. Endocrinologist. 2006; 16: 279–285.