Chiha Maguy, Samarasinghe Shanika, Kabaker Adam S
Division of Endocrinology and Metabolism, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA.
Section of Endocrine Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
J Intensive Care Med. 2015 Mar;30(3):131-40. doi: 10.1177/0885066613498053. Epub 2013 Aug 5.
Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should be initiated promptly targeting all steps of thyroid hormone formation, release, and action. Patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality of thyroid storm is currently reported at 10%. Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition.
甲状腺危象是一种于1926年首次被描述的内分泌急症，至今仍是诊断和治疗方面的挑战。没有任何实验室异常对甲状腺危象具有特异性，现有的评分系统是基于临床标准。从单纯性甲状腺功能亢进发展为甲状腺危象的确切机制尚不清楚。甲状腺激素反应增强以及游离激素可用性增加或突然增加常被认为是病因。患者表现出甲状腺功能亢进的夸张体征和症状以及不同程度的器官失代偿。应立即针对甲状腺激素形成、释放和作用的所有环节展开治疗。药物治疗无效的患者应接受治疗性血浆置换或甲状腺切除术。目前报道甲状腺危象的死亡率为10%。从甲状腺危象中存活下来的患者应接受针对其潜在甲状腺功能亢进的确定性治疗，以避免这种潜在致命疾病的任何复发。
