Department of Endocrinology, Metabolism & Medical Genetics, The Medical University of South Carolina, Charleston, North Carolina.
Am J Med Sci. 2013 Oct;346(4):338-40. doi: 10.1097/MAJ.0b013e31828ffcbc.
Thyroid storm is a complication of thyrotoxicosis with a 20% to 30% mortality rate characterized by hyperthermia, tachycardia and altered mental status. Rarely, thyroid storm may have an apathetic presentation. The authors present a 63-year-old woman with apathetic thyrotoxicosis and hypercalcemia. The action of thyroid hormones stimulating bone resorption more than bone formation is thought to cause increased bone demineralization and, occasionally, hypercalcemia. This occurs in the absence of malignancy, prolonged immobility, hypervitaminosis D and primary hyperparathyroidism. Her thyroid storm was medically managed and her hypercalcemia was treated with intravenous fluids, calcitonin and a bisphosphonate. This case describes the presence of hypercalcemia in a patient with apathetic thyroid storm with no other factors contributing to the hypercalcemia. In addition, this patient had significant elevation in serum calcium, which possibly contributed to her symptomatology. The calcium remained normal after the thyrotoxicosis resolved, which is typical of the hypercalcemia of thyrotoxicosis.
甲状腺危象是甲状腺功能亢进症的一种并发症，死亡率为 20%至 30%，其特征为高热、心动过速和精神状态改变。罕见情况下，甲状腺危象可能表现为冷漠型。本文介绍了一位 63 岁冷漠型甲状腺毒症伴高钙血症的女性患者。甲状腺激素的作用是刺激骨吸收多于骨形成，从而导致骨脱矿化增加，偶尔会导致高钙血症。这种情况发生在没有恶性肿瘤、长期卧床不动、维生素 D 过多症和原发性甲状旁腺功能亢进症的情况下。她的甲状腺危象采用药物治疗，高钙血症采用静脉补液、降钙素和双膦酸盐治疗。该病例描述了冷漠型甲状腺危象患者存在高钙血症，且没有其他因素导致高钙血症。此外，该患者血清钙显著升高，这可能导致了她的症状。甲状腺毒症得到治疗后，血钙恢复正常，这是甲状腺毒症性高钙血症的典型表现。
