Namatame Chihiro, Sonoo Tomohiro, Fukushima Kazutaka, Naraba Hiromu, Hashimoto Hideki, Nakamura Kensuke
Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Johnan-cho, Hitachi, Ibaraki, Japan.
Medicine (Baltimore). 2018 Feb;97(7):e9949. doi: 10.1097/MD.0000000000009949.
Various neurological manifestations are observed in thyroid storm patients but protracted disturbance of consciousness is rare.
A 58-year-old male was admitted to our hospital after a traffic accident.
Although awake on arrival, he fell into coma after admission. Based on the clinical symptoms and hyperthyroidism, the patient was diagnosed with thyroid storm (TS).
Even after improvement of hyperthyroidism, disturbance of consciousness was protracted. Considering the possibility of immune-related etiology, methylprednisolone pulse was started.
His consciousness level improved over a 3-month period, and he became able to walk with some assistance after 6 months.
His condition was atypical of TS-associated encephalopathy because of the long clinical course. Reversible splenial lesion was visible using brain imaging. In some cases of TS, disturbance of consciousness can be protracted for several months, but it is reversible. Therefore, it is necessary to judge the long-term neurological outcome carefully.
甲状腺危象患者可出现多种神经学表现，但持续性意识障碍较为罕见。
一名58岁男性在交通事故后被送入我院。
患者入院时清醒，但入院后陷入昏迷。根据临床症状及甲状腺功能亢进，患者被诊断为甲状腺危象（TS）。
即使甲状腺功能亢进有所改善，意识障碍仍持续存在。考虑到免疫相关病因的可能性，开始使用甲泼尼龙冲击治疗。
患者意识水平在3个月内有所改善，6个月后在一定帮助下能够行走。
由于临床病程较长，该患者的病情不符合TS相关性脑病的典型表现。脑成像显示可逆性胼胝体病变。在某些TS病例中，意识障碍可能持续数月，但可逆转。因此，有必要仔细判断长期神经学预后。
