Rana Abdul, Assad Salman, Abuzaid Mahmoud, Farooqi Ashar, Nolte Justin
Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA.
Neurology and Neurosurgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA.
Cureus. 2020 May 20;12(5):e8213. doi: 10.7759/cureus.8213.
Thyrotoxicosis-induced cardiomyopathy and cardiogenic shock (CS) can lead to sudden mortality in adults. Hemodynamic instability and collapse occur due to functional alterations in both peripheral circulation and myocardium. Thyroid storm (TS) increases preload and decreases afterload along with an increase in cardiac contractility and heart rate leading to high output acute failure. We present a case of a 30-year-old female who presented with a complaint of watery diarrhea and dehydration for almost a week. At her visit to the emergency room, she was unresponsive with hemodynamic collapse leading to altered mental status and tachycardia. The computed tomography (CT) scan of head was non-contributory. The condition worsened with respiratory distress, and eventually, mechanical ventilation with intubation was completed. Further, laboratory workup showed acute thyrotoxicosis. The severe cardiomyopathy on echocardiography with compromised left ventricle function and diffuse pulmonary congestion led to acute respiratory distress syndrome (ARDS). The multi-organ failure, impending ARDS and CS with encephalopathy led to the sudden death of a patient within 24 hours of intensive care unit (ICU) stay before even extracorporeal membrane oxygenation (ECMO) could be started.
甲状腺毒症性心肌病和心源性休克（CS）可导致成人猝死。由于外周循环和心肌的功能改变，会出现血流动力学不稳定和衰竭。甲状腺风暴（TS）会增加前负荷并降低后负荷，同时增加心脏收缩力和心率，导致高输出量急性衰竭。我们报告一例30岁女性病例，她主诉水样腹泻和脱水近一周。在她就诊于急诊室时，出现血流动力学衰竭，意识不清，伴有精神状态改变和心动过速。头部计算机断层扫描（CT）无异常发现。病情因呼吸窘迫而恶化，最终完成了气管插管机械通气。此外，实验室检查显示急性甲状腺毒症。超声心动图显示严重心肌病，左心室功能受损，弥漫性肺充血，导致急性呼吸窘迫综合征（ARDS）。多器官功能衰竭、即将发生的ARDS以及伴有脑病的CS导致患者在入住重症监护病房（ICU）24小时内突然死亡，甚至在体外膜肺氧合（ECMO）启动之前。
