未确诊格雷夫斯病患儿术中甲状腺危象的诊断与处理：一例报告
Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves' disease: a case report.
作者信息
Schaefer Amanda W, Solorzano Pedro J, Mavarez Ana C, Muñoz-Monaco Gustavo M
机构信息
Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
出版信息
JA Clin Rep. 2022 Jul 16;8(1):52. doi: 10.1186/s40981-022-00543-2.
BACKGROUND
Thyroid storm is a life-threatening manifestation of thyrotoxicosis and presents with fever, diaphoresis, tachycardia, hypertension, and widened pulse pressure.
CASE PRESENTATION
We present a case of intraoperative thyroid storm in a 12-year-old female undergoing posterior spinal fusion. Despite adequate depth of anesthesia and analgesia, the patient was persistently tachycardic and hypertensive. The surgical procedure was uneventful. A thyroid panel drawn immediately after surgery showed undetectable thyroid stimulating hormone (TSH) and high free thyroxine (T4) consistent with thyroid storm.
CONCLUSIONS
Intraoperative thyroid storm in a pediatric patient is extremely rare with nonspecific clinical symptoms. Low to undetectable TSH and elevated free T4 is diagnostic.
背景
甲状腺危象是甲状腺毒症的一种危及生命的表现，其症状包括发热、多汗、心动过速、高血压和脉压增宽。
病例报告
我们报告一例12岁接受后路脊柱融合术的女性患者术中发生甲状腺危象的病例。尽管麻醉和镇痛深度足够，但患者持续心动过速和高血压。手术过程顺利。术后立即进行的甲状腺功能检查显示促甲状腺激素（TSH）检测不到，游离甲状腺素（T4）升高，符合甲状腺危象。
结论
小儿患者术中发生甲状腺危象极为罕见，临床症状不具特异性。TSH降低至检测不到且游离T4升高具有诊断意义。
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