Shrum J M, Byers B, Parhar K
Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Surgery, Division of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada.
BMJ Case Rep. 2014 Jul 9;2014:bcr2014204589. doi: 10.1136/bcr-2014-204589.
Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with β-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.
摘要 一名19岁女性在试图上吊自杀未遂后出现窒息并并发心脏骤停，进而发生了创伤性甲状腺风暴这一罕见并发症。她最初因心脏骤停后处理被收入重症监护病房，进行气管插管并机械通气。在患者尽管使用了大量镇静剂仍持续高血压、心动过速且烦躁不安后，对甲状腺风暴展开了调查。甲状腺功能检查证实了临床对进行性甲状腺毒症的怀疑，相关影像学检查显示与甲状腺下半部受到带状创伤性压迫继发的甲状腺炎症相符。使用β受体阻滞剂和硫酰胺类药物治疗最终使她的甲状腺风暴状态得到缓解，甲状腺功能恢复正常。我们得出结论，对于包括上吊在内的钝性颈部损伤后的所有高代谢患者，均应考虑创伤性甲状腺风暴，且传统的甲亢治疗方法可成功应用。
