Department of Endocrinology, Max Health Care, Max Healthcare Institute Ltd., New Delhi, India.
Thyroid. 2012 Dec;22(12):1283-6. doi: 10.1089/thy.2011.0353. Epub 2012 Oct 15.
Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS.
A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL).
Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state.
The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably a life-saving treatment in patients who are exposed to amounts of thyroid hormone far in excess of that usually produced by the thyroid gland.
甲状腺危象（TS）是一种罕见的危及生命的疾病，其特征是由内源性或外源性危急事件、疾病/损伤、急性碘负荷以及甲状腺或非甲状腺手术引起的发热和精神状态改变。大量甲状腺提取物被广泛使用，但尽管在甲状腺功能减退或甲状腺功能正常的患者中不推荐使用，但它们仍然被广泛使用。使用这些产品可能是危险的，并导致危及生命的甲状腺危象。在这里，我们报告了一例由意外摄入高剂量合成甲状腺提取物中的三碘甲状腺原氨酸（T3）和甲状腺素（T4）引起的甲状腺危象。血浆置换可能被认为是治疗外源性甲状腺危象的一种选择。
一名 62 岁的女性，无明显既往病史，因严重肌痛、发热、心动过速和血压 170/80mmHg 就诊，24 小时内精神状态改变。神经系统检查未发现任何局灶性缺陷或脑膜刺激征。进一步调查显示，她一直在服用甲状腺补充剂。该患者意外服用了一批甲状腺提取物药丸，其中 T4 含量意外偏高。她的游离 T3（FT3）和游离 T4（FT4）水平被发现远远超过实验室可读范围（FT3>30pg/ml；FT4>6.06ng/dL；促甲状腺素[TSH]=0.07IU/ml）。
在开始对甲状腺危象进行标准保守治疗的三天后，患者出现了后部可逆性脑病综合征，导致癫痫发作。她仍然没有反应，精神状态不佳。由于明确的外源性甲状腺危象病因，决定进行血浆置换。连续两天进行的血浆置换被证明是治疗甲状腺危象的成功措施，改善了她的甲状腺状况和精神状态。
在甲状腺功能减退和甲状腺功能正常的患者中不恰当地使用甲状腺提取物会导致危及生命的甲状腺危象。在接触到远远超过甲状腺通常产生的甲状腺激素量的患者中，血浆置换可能是一种挽救生命的治疗方法。
