Complications of toxic nodular goiter

toxic nodular goiter can be complicated by the diseases?

hyperthyroid heart disease, toxic nodular goiter is the prominent clinical manifestations, may also occur in the long history, symptoms of Graves disease, especially in elderly patients, so focus on them here.

1. etiology and pathogenesis of thyroid hormone has a direct excitatory effect on the myocardium, can increase the myocardial Na-K-ATP enzyme and sarcoplasmic reticulum Ca2-ATP in the myosin ATP enzyme and enzyme activity, increased cardiac contractility force, increased heart stroke volume, cardiac load increase due to compensatory hypertrophy of ventricular much overlooked, while thyroid hormone can increase atrial β-receptor number and the stress, the role and the roles of catecholamines on myocardial collaboration, such as the patient is still combined with other organic heart disease, the heart of the load heavier and more prone to heart failure.

2. clinical performance

(1) arrhythmia: common before a period of contraction and atrial fibrillation, both of which were paroxysmal or persistent, in the hyperthyroid heart disease reported in the literature the incidence of atrial fibrillation was 10% to 28%, when control symptoms of hyperthyroidism after multiple self-healing, Yuen et al reported a group of 165 cases of hyperthyroidism in patients with atrial fibrillation, 101 patients (61%) in atrial fibrillation after symptoms of hyperthyroidism is controlled away, all the time in their own recovery by RIA or anti-thyroid drug treatment after 4 months or less.

(2) enlargement of the heart: the longer the duration of patients with severe hyperthyroidism, due to cardiac overload caused by enlargement of the heart for a long time, due to left ventricular dilatation, resulting in the relative mitral regurgitation, the apex can be heard and Ⅱ ~ Ⅲ grade systolic murmur, hyperthyroidism caused solely by those who, after control of hyperthyroidism, the heart more than to return to normal, a small number of longer duration, severe heart attack can be left permanently enlarged heart.

(3) heart failure: elderly hyperthyroid patients and associated with other structural heart disease in patients with hyperthyroidism, heart failure prone, and sometimes cover up the performance of hyperthyroidism caused by misdiagnosis or delayed treatment.