Department of Emergency, Peking University People's Hospital, Beijing 100044, China.
Am J Emerg Med. 2012 Nov;30(9):2094.e5-6. doi: 10.1016/j.ajem.2012.01.003. Epub 2012 Mar 3.
We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation--rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically. Prompt treatments such as mechanical ventilation, plasma exchange, and continuous venovenous hemofiltration were preformed, along with antithyroid medication. The patient finally survived after 3 weeks of intensive care. We herein discuss the possible mechanisms of these metabolic disorders in thyroid crisis and possible therapeutic measures that could be used to reduce mortality.
我们描述了一例甲状腺危象伴低血糖、乳酸性酸中毒、多器官功能衰竭和弥散性血管内凝血的病例——这些都是甲状腺危象罕见但严重的并发症。患者为 59 岁中国女性，表现为心力衰竭和心房颤动的证据。对血液样本的分析得出了惊人的结果：她的血糖为 1.7mmol/L，乳酸大于 15mmol/L，动脉 pH 值为 6.94。肝酶（丙氨酸氨基转移酶，1846U/L；天冬氨酸氨基转移酶，6242U/L）和胆红素迅速而显著升高。迅速进行了机械通气、血浆置换和持续静脉-静脉血液滤过等即时治疗，并使用了抗甲状腺药物。经过 3 周的重症监护，患者最终存活下来。我们在此讨论了甲状腺危象中这些代谢紊乱的可能机制以及可能用于降低死亡率的治疗措施。
