Department of Anesthesiology and Perioperative Medicine, Penn State University College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Anesthesiology and Pain Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Am J Case Rep. 2021 Nov 6;22:e933751. doi: 10.12659/AJCR.933751.
BACKGROUND Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening endocrine emergency that presents with multisystem involvement. Patients present with pronounced signs of hyperthyroidism, fever, tachycardia, and differing severities of multisystem dysfunction and decompensation. Early recognition and prompt initiation of treatment are important. The development of thyroid storm in patients with no established history of underlying hyperthyroidism is rare. CASE REPORT In this case report, we describe the occurrence of thyroid storm in a 27-year-old man without an established history of underlying thyroid disease, who was admitted to the Intensive Care Unit (ICU) with a high ileostomy output and fever. Although initially treated for possible sepsis, the diagnosis of thyroid storm was made only after a thorough workup was initiated and he was found to have underlying Graves' disease. Prompt treatment resulted in the resolution of symptoms and avoided potential morbidity and mortality. CONCLUSIONS This case highlights the potential difficulty in diagnosing thyroid storm in a patient admitted to the ICU without an established history of hyperthyroidism. Upgrade in care, timely diagnosis, and initiation of appropriate therapy led to a favorable outcome. Clinicians should consider hyperthyroidism as a possible cause of high ileostomy output, especially when it does not resolve with traditional treatment and no obvious cause can be identified. This case demonstrates the challenges presented when the patient's history and clinical signs are ambiguous and stresses the importance of "outside the box" thinking.
甲状腺风暴，亦称甲状腺危象，是一种罕见但危及生命的内分泌急症，多系统受累。患者表现为明显的甲状腺功能亢进征象、发热、心动过速，以及不同程度的多系统功能障碍和失代偿。早期识别和及时开始治疗非常重要。在无明确既往甲状腺功能亢进病史的患者中发生甲状腺风暴较为罕见。
在本病例报告中，我们描述了一位 27 岁男性发生甲状腺风暴的情况，该患者无明确既往甲状腺疾病病史，因高回肠造口输出量和发热而入住重症监护病房（ICU）。尽管最初被诊断为可能的败血症进行治疗，但仅在进行了全面检查并发现其患有潜在的格雷夫斯病后才诊断为甲状腺风暴。及时治疗导致症状缓解，并避免了潜在的发病率和死亡率。
本病例强调了在无明确既往甲状腺功能亢进病史的 ICU 患者中诊断甲状腺风暴的潜在困难。升级治疗、及时诊断和开始适当的治疗可带来良好的结局。临床医生应考虑甲状腺功能亢进症是高回肠造口输出量的可能原因，特别是在传统治疗无效且无法确定明显原因的情况下。本病例展示了当患者的病史和临床体征不明确时所带来的挑战，并强调了“跳出框框”思维的重要性。
