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甲状腺危象在重症监护病房表现为感染性休克:病例系列。

Thyroid storm presenting as septic shock in the intensive care unit: A Case Series.

机构信息

Department of Critical Care Medicine, B & C Medical College and Teaching Hospital, Birtamode, Nepal.

Department of Anaesthesia & Critical Care, B&C Medical College Teaching Hospital, Birtamode, Nepal.

出版信息

JNMA J Nepal Med Assoc. 2020 Jan;58(221):48-51. doi: 10.31729/jnma.4552.

Abstract

Thyroid storm is a rare endocrine emergency that rarely presents with septic shock. It occurs in thyrotoxic patients and is manifested by decompensation of multiple organs, triggered by severe stress. The diagnosis and response to treatment is made by Burch-Wartofsky point scale or Japanese thyroid association criteria due to lack of pathophysiology of thyroid storm. We reported series of patients that presented with altered sensorium, cough, fever, palpitation, shortness of breath and shock. Patient were treated initially for septic shock, later diagnosed as thyroid storm and was treated with oral carbimazole, propanolol and digoxin. From this, we want to emphasize that thyroid storm can have any presentation that should be kept in differential diagnosis of septic shock not responding to usual treatment; early diagnosis and treatment with oral medication can decrease morbidity and mortality in rural setting where intravenous form of antithyroid drug are not available for thyroid storm. Keywords: sepsis; septic shock; thyroid storm.

摘要

甲状腺危象是一种罕见的内分泌急症,很少表现为感染性休克。它发生在甲状腺功能亢进的患者中,由于严重的应激而导致多个器官失代偿,其诊断和治疗反应是通过 Burch-Wartofsky 评分或日本甲状腺协会标准进行的,因为缺乏甲状腺危象的病理生理学依据。我们报告了一系列以意识改变、咳嗽、发热、心悸、呼吸急促和休克为表现的患者。最初患者被诊断为感染性休克,后被诊断为甲状腺危象,给予口服甲巯咪唑、普萘洛尔和地高辛治疗。由此,我们想强调的是,甲状腺危象可能有任何表现,应与对常规治疗无反应的感染性休克进行鉴别诊断;在农村地区,静脉用抗甲状腺药物不可用于治疗甲状腺危象,因此早期诊断和口服药物治疗可以降低发病率和死亡率。关键词:脓毒症;感染性休克;甲状腺危象。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c324/7580483/1b890a667694/JNMA-58-221-48-g1.jpg

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