Chantra Marut, Limsuwan Alisa, Mahachoklertwattana Pat
Division of Critical Care Medicine, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Pediatr Int. 2016 Oct;58(10):1080-1083. doi: 10.1111/ped.13102.
A 15-year-old girl with Graves' disease presented with hypotension after methimazole and propranolol were re-started for hyperthyroidism. She was found to have pulmonary artery hypertension resulting in obstructive shock. Thyroid storm was diagnosed according to Burch and Wartofsky score. She was promptly treated with anti-thyroid drugs, inorganic iodide, corticosteroid, and respiratory support. Pulmonary hypertension was treated with inhaled nitric oxide until the clinical status improved. Propranolol was withdrawn due to poor cardiac function. We herein present a unique case of a difficult-to-treat Graves' disease presenting with severe pulmonary hypertension resulting in low cardiac output thyroid storm.
一名15岁患有格雷夫斯病的女孩，在因甲状腺功能亢进症重新开始服用甲巯咪唑和普萘洛尔后出现低血压。她被发现患有肺动脉高压，导致梗阻性休克。根据伯奇和瓦尔托夫斯基评分诊断为甲状腺危象。她立即接受了抗甲状腺药物、无机碘化物、皮质类固醇和呼吸支持治疗。肺动脉高压采用吸入一氧化氮治疗，直至临床状况改善。由于心功能不佳，停用了普萘洛尔。我们在此报告一例独特的难治性格雷夫斯病病例，该病例伴有严重肺动脉高压，导致低心输出量甲状腺危象。
