Hassan Syed, Ayoub Walaa, Hassan Mona, Wisgerhof Max
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
BMJ Case Rep. 2014 Apr 12;2014:bcr2013202338. doi: 10.1136/bcr-2013-202338.
A 62-year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Thyroid-stimulating hormone was found to be 168 μIU/mL (nl. 0.3-5 μIU/mL) and free thyroxine (FT4) was <0.2 ng/dL (nl. 0.8-1.8 ng/dL). He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. He received 500 μg of intravenous levothyroxine in the first 18 h of therapy, and 150 µg intravenous daily thereafter. Haemodynamic improvement, along with complete recovery of mental status, occurred after 48 h. Twelve hours after the initiation of therapy, FT4 was 0.96 ng/dL. The patient was maintained on levothyroxine 175 (g POorally daily. A thyroid ultrasound showed diffuse heterogeneity. The 24 hour excretion of iodine was 3657 (mcg (25-756 ( mcg). The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease.
一名62岁男性在开始使用胺碘酮治疗心房颤动3周后出现心动过缓、体温过低和呼吸衰竭。发现促甲状腺激素为168 μIU/mL（正常范围0.3 - 5 μIU/mL），游离甲状腺素（FT4）<0.2 ng/dL（正常范围0.8 - 1.8 ng/dL）。他接受了静脉补液、血管加压药治疗和应激剂量的类固醇；他被插管并入住重症监护病房。在治疗的前18小时内，他接受了500 μg静脉注射左甲状腺素，此后每天静脉注射150 μg。48小时后出现血流动力学改善以及精神状态完全恢复。治疗开始12小时后，FT4为0.96 ng/dL。患者继续口服左甲状腺素175 μg/d。甲状腺超声显示弥漫性异质性。24小时碘排泄量为3657 μg（正常范围25 - 756 μg）。文献中仅有的两例胺碘酮诱发的黏液性水肿昏迷病例报告显示，尽管进行了支持治疗和甲状腺激素替代治疗，患者仍死亡。该病例是对胺碘酮诱发的黏液性水肿昏迷研究最深入的病例，患者有亚临床甲状腺疾病史。
