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甲状腺危象:1例通过积极使用抗甲状腺药物和类固醇冲击疗法迅速逆转血流动力学衰竭的病例

Thyroid storm: a case of haemodynamic failure promptly reversed by aggressive medical therapy with antithyroid agents and steroid pulse.

作者信息

Andrade Luz Ivan, Pereira Tiago, Catorze Nuno

机构信息

Nephrology, Centro Hospitalar do Médio Tejo EPE, Unidade de Torres Novas, Torres Novas, Santarém, Portugal.

Intensive Care Unit, Centro Hospitalar do Médio Tejo EPE, Unidade de Abrantes, Abrantes, Santarém, Portugal.

出版信息

BMJ Case Rep. 2018 Dec 14;11(1):e226669. doi: 10.1136/bcr-2018-226669.

Abstract

Hyperthyroidism is a common metabolic disorder, although its presentation as an endocrine emergency called thyroid storm is rare. Here we review a case of a thyroid storm as the initial presentation of thyrotoxicosis, with multiple organ failure and haemodynamic collapse due to low-output cardiac dysfunction. Quick intervention with aggressive antithyroid therapy, including steroid pulse, and supportive intensive care measures led to an outstanding improvement and full recovery. The present case clearly shows the beneficial impact of initial clinical suspicion resulting in an early diagnosis and intensive therapy. Moreover, it supports the additional role of steroids to aggressive antithyroid strategy in order to control associated deleterious systemic inflammatory reactions.

摘要

甲状腺功能亢进症是一种常见的代谢紊乱疾病,尽管其作为一种称为甲状腺危象的内分泌急症表现较为罕见。在此,我们回顾一例以甲状腺危象为甲状腺毒症初始表现的病例,该患者因低输出量心功能不全出现多器官功能衰竭和血流动力学崩溃。迅速采取积极的抗甲状腺治疗,包括类固醇冲击治疗,并辅以支持性重症监护措施,使病情显著改善并完全康复。本病例清楚地显示了初始临床怀疑对早期诊断和强化治疗的有益影响。此外,它支持了类固醇在积极抗甲状腺策略中的额外作用,以控制相关的有害全身炎症反应。

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本文引用的文献

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Acute and emergency care for thyrotoxicosis and thyroid storm.甲状腺毒症和甲状腺危象的急性及急诊处理
Acute Med Surg. 2015 May 12;2(3):147-157. doi: 10.1002/ams2.104. eCollection 2015 Jul.
10
Thyroid storm: an updated review.甲状腺危象:最新综述
J Intensive Care Med. 2015 Mar;30(3):131-40. doi: 10.1177/0885066613498053. Epub 2013 Aug 5.

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