Satoh Tetsurou, Isozaki Osamu, Suzuki Atsushi, Wakino Shu, Iburi Tadao, Tsuboi Kumiko, Kanamoto Naotetsu, Otani Hajime, Furukawa Yasushi, Teramukai Satoshi, Akamizu Takashi
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan.
Endocr J. 2016 Dec 30;63(12):1025-1064. doi: 10.1507/endocrj.EJ16-0336. Epub 2016 Oct 15.
Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.
甲状腺危象是一种内分泌急症，其特征是由于严重甲状腺毒症导致多器官功能衰竭，常与诱发疾病相关。早期怀疑、及时诊断和强化治疗将提高甲状腺危象患者的生存率。由于其罕见性和高死亡率，很难开展针对甲状腺危象治疗的前瞻性干预研究。我们，日本甲状腺协会和日本内分泌学会特别工作组委员会，此前制定了新的诊断标准，并在日本全国范围内对甲状腺危象进行了调查。对356例患者临床数据的详细分析显示，日本的死亡率仍然很高（约11%），多器官功能衰竭和急性心力衰竭是常见的死亡原因。此外，有人建议采用抗甲状腺药物、无机碘化物、皮质类固醇和β-肾上腺素能拮抗剂的多模式治疗来提高这些患者的死亡率。基于全国性调查和额外文献检索获得的证据，我们在此制定了甲状腺危象管理的临床指南。本指南包括15条关于治疗甲状腺毒症以及中枢神经系统、心血管系统和肝胃肠道器官功能衰竭的建议、重症监护病房的收治标准和预后评估。我们还提出了甲状腺危象的预防方法、确定性治疗的作用以及甲状腺危象治疗的未来前瞻性试验计划。我们希望本指南对日本以及全世界的许多医生在甲状腺危象的管理及其预后改善方面有所帮助。
