Shah Syed Raza, Millan Terance, Alamzaib Sardar Muhammad, Luu Sue-Wei
Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA.
J Community Hosp Intern Med Perspect. 2018 Dec 11;8(6):368-369. doi: 10.1080/20009666.2018.1547090. eCollection 2018.
Thyroid storm, defined as an endocrine emergency in 1926, remains a challenge for physicians in the 21 century. The mortality rate of untreated thyroid storm is very high. Hence, if a thyroid storm is suspected, treatment should not be delayed. This disease can be fatal! We present the case of a 86-year-old female presenting with altered mental status. All the tests came out negative except for elevated free t4 (ft4) with a very low TSH level (ft4-7.87, TSH< 0.005). Patient was diagnosed with thyroid storm in the setting of subclinical hypothyroidism and improved significantly with treatment. Furthermore, it is essential to confirm the TSH level in a patient with subclinical hypothyroidism. By carefully finding the extent of the disease, one can easily distinguish between hypo-or hyper- thyroid disease. The clinical features of thyroid storm may be related to other co-morbidities which makes diagnosis a clinical challenge. Nonetheless, it is important to be aware of the possibility of development of a thyroid storm in patients with a history of subclinical hypothyroidism. In addition, patients, if diagnosed with a thyroid storm, should be treated immediately with appropriate medications since thyrotoxicosis is life threatening.
甲状腺风暴于1926年被定义为一种内分泌急症，在21世纪对医生来说仍是一项挑战。未经治疗的甲状腺风暴死亡率非常高。因此，如果怀疑发生甲状腺风暴，不应延误治疗。这种疾病可能是致命的！我们报告一例86岁女性出现精神状态改变的病例。除游离T4（FT4）升高且促甲状腺激素（TSH）水平极低（FT4 - 7.87，TSH < 0.005）外，所有检查结果均为阴性。患者在亚临床甲状腺功能减退的情况下被诊断为甲状腺风暴，经治疗后显著改善。此外，对于亚临床甲状腺功能减退患者，确认TSH水平至关重要。通过仔细确定疾病程度，能够轻易区分甲状腺功能减退或亢进疾病。甲状腺风暴的临床特征可能与其他合并症有关，这使得诊断成为一项临床挑战。尽管如此，了解有亚临床甲状腺功能减退病史的患者发生甲状腺风暴的可能性很重要。此外，如果患者被诊断为甲状腺风暴，应立即使用适当药物进行治疗，因为甲状腺毒症会危及生命。
