Department of Cardiology, National University Heart Center, Singapore, Singapore.
Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.
Front Endocrinol (Lausanne). 2021 Aug 20;12:725559. doi: 10.3389/fendo.2021.725559. eCollection 2021.
Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.
甲状腺危象是一种罕见但危及生命的内分泌急症，多器官受累和衰竭的死亡率为 10-30%。鉴于这种情况罕见，且一线药物治疗效果显著，因此，很少使用体外治疗方法，且这些方法研究不足，现有的证据仅来自病例报告和病例系列。我们描述了一名 28 岁男性，因甲状腺危象导致院外心脏骤停。尽管进行了常规的一线药物治疗，但他仍出现心源性休克和循环衰竭，静脉注射艾司洛尔，以及多器官衰竭。他需要进行治疗性血浆置换、同时进行肾脏替代治疗和静脉-动脉体外膜氧合，这是文献中少数报道的病例之一。尽管在三种体外系统上进行了临床稳定和三碘甲状腺原氨酸水平的改善，但他还是遭受了不可逆转的缺氧缺血性脑损伤。我们回顾了早期治疗性血浆置换和体外膜氧合的应用，以及在常规药物治疗无效或禁忌时开发的其他新型体外治疗方法。该病例还强调了甲状腺危象管理的复杂性，呼吁在甲状腺心脏病中谨慎使用β受体阻滞剂，并密切监测和及时器官支持。
