갑상선 기능항진증에서 호흡곤란, Dyspnea in hyperthyroidism

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네이버 백과사전에 갑상선 기능항진증 증상을 찾아보면이 환자가 호소하는 증상들이 있 습니다.

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실제로 갑상선 기능이 항진된 상태입니다.

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① 산소 소비(oxygen consumption)와  이산화탄소 발생(carbon dioxide (CO2)) 증가    이와 변화는 결과 저산소증, 과탄산혈증을 각각 일으키고     이 두 가지의 변화는 ventilation을 자극할것이다.② 호흡 약화는 호흡곤란의 중요한 원인이며, 감소된 운동 능력은 크게 호흡 근육 약화와 감소된 폐용적 때문이다.③ 고이터가 큰 경우에는 기도 폐쇄가 생길 수 있음니다.④ 갑상선기능항진증은 기저 천식을 악화시킬 수 있음니다.⑤ 수축기 혈압이 증가됩니다.

Increased ventilatory drive — Hyperthyroidism is associated with an increased ventilatory drive in response to hypoxemia and hypercapnia. With exercise, hyperthyroid patients are more dyspneic than normal subject controls for the same level of work, but there is no difference in dyspnea for the same level of ventilation. Thus, increased ventilatory drive seems to account for dyspnea on exertion in hyperthyroid patients . The mechanism for increased ventilatory drive is uncertain, but beta-adrenergic blockade reduces it to normal, suggesting that adrenergic stimulation plays a role.Respiratory muscle weakness — Hyperthyroidism causes respiratory muscle weakness. In a study of 20 hyperthyroid patients, both maximal expiratory and inspiratory pressures fell with increasing degrees of hyperthyroidism. Respiratory muscle force increased to normal after treatment. Hyperthyroidism can also cause abnormalities in pulmonary function, with reductions in forced expiratory volume in 1 second (FEV1) and vital capacity that improves with treatment .Pulmonary hypertension — Pulmonary hypertension, a known complication of neonatal thyrotoxicosis, has also been reported in adults with hyperthyroidism, with over 70 percent of cases occurring in women. The mechanism of pulmonary hypertension in these patients is unclear, but pulmonary pressures drop with institution of medical therapy for the hyperthyroidism.

Ref. UpToDate 2017.7.11