Abstract
A Case Report with Complete Heart Block Related with Hypothyroidism Emerging After Thyroidectomy The development of complete heart block is very rare in hypothyroid patients. A 22 year-old female patient was accepted to our clinic with the symptoms of the dizziness and easy fatigue. It was learned that she had these complaints after the thyroidectomy operation performed 11 months ago because of the cosmetic reasons. She was not using any drug that affects the heart rate. In her physical examination the pulse rate was measured as 34/min. Blood pressure was 90/60 mmHg. Electrocardiographic examination showed the complete heart block. Echocardiographic examination was normal except minimal mitral regurgitation. The biochemical examination showed that thyroid hormones decreased significantly [FT3:1.86 pg/ml (N:2.30-4.20) FT4:0.48 ng/ml (N:0.80-1.50)], TSH was found very high [169.5 IU/ml (N:0.35-5.50 IU/ml)]. Thyroid replacement therapy was begun and the dosage was increased gradually. The hormone levels reached to normal levels at the second month of the therapy (FT3:3.44 pg/ml. FT4:1.78 ng/ml, TSH:0.28 IU/ml). But in spite or these values, me heart block persisted and the permanent cardiac pacemaker implantation was planned and suggested to the patient. But she refused this decision and was discharged from the hospital with her own request. It was learned from her relatives with phone that approximately four months later after her discharge she died suddenly in her home. In conclusion, it can be thought Hipotiroidili hastalarda tam kalp bloku gelismesi cok nadirdir. Yirmi iki yasindaki bayan hasta bas donmesi ve cabuk yorulma nedeniyle klinigimize kabul edildi. Hastanin kozmetik nedenlerden dolayi 11 ay once yapilan tiroidektomi operasyonundan sonra bu sikayetlerinin oldugu ogrenildi. Kalp hizini etkileyen herhangi bir ilac kullanmiyordu. Fizik muayenesinde nabiz hizi 34/dk. kan basinci 90/60 mmHg alindi. EKG'de tam kalp bloku mevcuttu. Ekokardiyografik inceleme hafif mitral yetmezligi disinda normal bulundu. Biyokimyasal inceleme uroid hormonlarinin onemli derecede dustugunu [FT3:1.86pg/ml (N:2.30-4.20), FT4:0.48 ng/ml (N:0.80-1.50)] ve TSH'in cok yuksek [TSH: 169.5 TU/ml (N:0.35-5.50 IU/ml)] oldugunu gosterdi. Tiroid replasman tedavisi baslandi ve doz dereceli olarak artirildi. Hormon duzeyleri tedavinin 2. ayinda normal duzeylere ulasti (FT3-.3.44 pg/ml, FT4:1.78 ng/ml, TSH0.28 IU/ml). Fakat bu degerlere ragmen kalp bloku sebat edince, kalici kalp pili takilmasi planlandi ve hastaya onerildi. Fakat hasta bu karan reddetti ve kendi istegiyle taburcu edildi. Hastanin taburcu olduktan yaklasik 4 ay sonra evde aniden oldugu telefonla hasta yakinlarindan ogrenildi. Sonuc olarak, hormon degerlerinin normale donmesine ragmen, hipotiroidiye bagli gelisen tam kalp blokunun hormon tedavisine direncli, olabilecegi dusunulebilir. Tam kalp bloku, iletim sistemindeki kalici hasardan dolayi normal sinus ritmine donmeyebilir. Mumkun olan en kisa bir surede kalici kalp pili takilmazsa sonuc fatal olabilir.
Published Version
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