甲状腺功能减退危象：口服还是静脉治疗？两例报告。
Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases.
作者信息
Gadaen Rens Jr, Tummers-de Lind van Wijngaarden Roderick F
机构信息
Department of Internal Medicine, Division of Endocrinology and Thyroid Centre, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
出版信息
Eur J Case Rep Intern Med. 2021 Sep 10;8(9):002752. doi: 10.12890/2021_002752. eCollection 2021.
BACKGROUND
Hypothyroid crisis, or myxoedema coma, is a rare condition with high mortality and must be treated promptly. Even though it may be unfavourable, most guidelines only focus on intravenous drug administration due to lack of data on oral treatment.
METHODS/RESULTS: The course of oral treatment in two patients admitted in our hospital is described. Patients were treated with levothyroxine 1.3 μg/kg and liothyronine 25 μg twice daily, followed after 1 week with only levothyroxine 1.3 μg/kg daily. Oral treatment was successful in both patients without complications or side-effects.
CONCLUSIONS
Oral substitution is an appropriate alternative to intravenous substitution, which has potential disadvantages and is associated with higher mortality.
LEARNING POINTS
Hypothyroid crisis or myxoedema coma is a rare condition with a high mortality rate, so early diagnosis and prompt treatment are necessary.High-dose intravenous treatment is associated with higher mortality, so oral substitution may be an acceptable approach, especially as intravenous medicines are not widely available.
背景
甲状腺功能减退危象，即黏液性水肿昏迷，是一种罕见疾病，死亡率高，必须迅速治疗。尽管口服治疗可能不太理想，但由于缺乏口服治疗的数据，大多数指南仅关注静脉用药。
方法/结果：描述了我院收治的两名患者的口服治疗过程。患者接受左甲状腺素1.3μg/kg和碘塞罗宁25μg，每日两次，1周后仅接受左甲状腺素1.3μg/kg，每日一次。两名患者口服治疗均成功，无并发症或副作用。
结论
口服替代是静脉替代的合适替代方法，静脉替代有潜在缺点且与较高死亡率相关。
经验教训
甲状腺功能减退危象或黏液性水肿昏迷是一种罕见疾病，死亡率高，因此早期诊断和及时治疗很有必要。高剂量静脉治疗与较高死亡率相关，因此口服替代可能是一种可接受的方法，尤其是在静脉用药不易广泛获得的情况下。
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