Osada Erika, Hiroi Naoki, Sue Mariko, Masai Natsumi, Iga Ryo, Shigemitsu Rika, Oka Reiko, Miyagi Masahiko, Iso Kaoru, Kuboki Koji, Yoshino Gen
Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine (Omori), Toho University School of Medicine, Tokyo, Japan.
Thyroid Res. 2011 Apr 14;4(1):8. doi: 10.1186/1756-6614-4-8.
Thyroid storm is a condition in which multiple organ dysfunction results from failure of the compensatory mechanisms of the body owing to excessive thyroid hormone activity induced by some factors in patients with thyrotoxicosis. While diabetic ketoacidosis (DKA) is an important trigger for thyroid storm, simultaneous development of DKA and thyroid storm is rare.
A 59-year-old woman with no history of either diabetes mellitus or thyroid disease presented to our hospital because of developing nausea, vomiting and diarrhea for 2 days. Physical examination showed mild disturbance of consciousness, fever, and tachycardia. There were no other signs of thyrotoxicosis. Laboratory studies revealed elevation of random blood glucose and glycosylated hemoglobin, strongly positive of urine acetone, and metabolic acidosis. Since DKA was diagnosed, we initiated the patient on treatment with administration of insulin and adequate fluid replacement. Although the hyperglycemia and acidosis were immediately relieved, the disturbance of consciousness and tachycardia remained persistent. Levels of FT3 and FT4 were extremely high and TSH was below the detectable limit. TRAb was positive. The thyroid storm score of Burch & Wartofsky was 75/140, and the thyroid storm diagnostic criteria of the Japan Thyroid Association were satisfied. Oral administration of thiamazole, potassium iodide and propranolol resulted in immediate relief of the tachycardia.
We encountered a case of thyroid storm associated with Graves' disease covered by DKA. Thyroid storm and DKA are both potentially fatal, and the prognosis varies depending on whether or not these conditions are detected and treated sufficiently early. The thyroid storm diagnostic criteria prepared in 2008 by the Japan Thyroid Association are very simple as compared to the Burch & Wartofsky scoring system for thyroid storm. The Japanese criteria may be useful in the diagnosis of this condition since they enable clinicians to identify a broad range of cases with thyroid storm. When dealing with cases of DKA or thyroid storm, it seems essential to bear in mind the possibility of the coexistence of these two diseases.
甲状腺危象是一种由于甲状腺毒症患者某些因素诱发甲状腺激素活性过高，导致机体代偿机制失效而引发多器官功能障碍的病症。虽然糖尿病酮症酸中毒（DKA）是甲状腺危象的一个重要诱因，但DKA与甲状腺危象同时发生的情况较为罕见。
一名59岁女性，既往无糖尿病或甲状腺疾病史，因出现恶心、呕吐和腹泻2天前来我院就诊。体格检查显示轻度意识障碍、发热和心动过速。无其他甲状腺毒症体征。实验室检查显示随机血糖和糖化血红蛋白升高，尿酮体强阳性，以及代谢性酸中毒。由于诊断为DKA，我们开始给予患者胰岛素治疗并充分补液。虽然高血糖和酸中毒立即得到缓解，但意识障碍和心动过速仍持续存在。FT3和FT4水平极高，TSH低于可检测限度。TRAb呈阳性。Burch & Wartofsky甲状腺危象评分为75/140，满足日本甲状腺协会的甲状腺危象诊断标准。口服甲巯咪唑、碘化钾和普萘洛尔后，心动过速立即缓解。
我们遇到了一例由DKA掩盖的与格雷夫斯病相关的甲状腺危象病例。甲状腺危象和DKA都有潜在致命性，其预后取决于这些病症是否被足够早期地检测和治疗。与Burch & Wartofsky甲状腺危象评分系统相比，日本甲状腺协会2008年制定的甲状腺危象诊断标准非常简单。日本的标准可能有助于诊断这种病症，因为它们能使临床医生识别出广泛的甲状腺危象病例。在处理DKA或甲状腺危象病例时，牢记这两种疾病并存的可能性似乎至关重要。
