Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea.
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Medicine (Baltimore). 2022 Aug 12;101(32):e29359. doi: 10.1097/MD.0000000000029359.
Cardiac arrest due to thyroid storm is a very rare clinical feature with high mortality that presents as multiorgan dysfunction. The mortality rate under this condition is close to 30%, even with appropriate treatment. Most thyroid storms occur in patients with long-standing untreated hyperthyroidism.
A 67-year-old woman, who had no specific medical history, was admitted with stupor mentality after a pedestrian traffic accident.
The patient had a Burch and Wartofsky score of 80, well beyond the criteria for diagnosis of a thyroid storm (>45 points).
Venoarterial extracorporeal membrane oxygenation (ECMO) was performed due to persistent unstable vital signs and findings of right ventricular dysfunction after return of spontaneous circulation after cardiopulmonary resuscitation. Circulatory assist with ECMO was performed for 8 days using a beta blocker, steroids, thionamide, and Lugol iodine solution.
Myocardial function and thyroid hormone levels were rapidly normalized. The patient's mental state recovered, and patient was discharged on day 36 maintaining medication.
Diagnosis of a thyroid storm in patients with multiple trauma is very difficult, because most trauma patients have symptoms of tachycardia, altered mental status, and abdominal pain that appear in thyrotoxic events. However, when unexplained shock without bleeding evidence occurs in patients with multiple trauma, a thyroid function test should be performed to rule out thyroid storm. Moreover, if hyperthyroidism is observed in a trauma patient, even if there is no history of hyperthyroidism, the possibility of a thyroid storm must be considered along with medical support treatment such as ECMO in patient with cardiogenic shock.
甲状腺危象导致的心脏骤停是一种非常罕见的临床特征，其死亡率很高，表现为多器官功能障碍。即使给予适当的治疗，这种情况下的死亡率也接近 30%。大多数甲状腺危象发生在长期未经治疗的甲状腺功能亢进症患者中。
一位 67 岁女性，无特殊病史，因行人交通事故后出现昏迷状态被收治入院。
患者的 Burch 和 Wartofsky 评分达到 80 分，远远超过甲状腺危象的诊断标准（>45 分）。
心肺复苏后自主循环恢复，但生命体征仍持续不稳定，发现右心室功能障碍，因此进行了静脉动脉体外膜肺氧合（ECMO）。使用β受体阻滞剂、类固醇、硫脲类药物和卢戈碘溶液进行循环辅助治疗，ECMO 辅助循环治疗持续了 8 天。
心肌功能和甲状腺激素水平迅速恢复正常。患者的精神状态恢复，在第 36 天维持药物治疗后出院。
多发伤患者甲状腺危象的诊断非常困难，因为大多数创伤患者都有心动过速、精神状态改变和腹痛等症状，这些症状在甲状腺毒症事件中出现。然而，在多发伤患者中，如果出现不明原因的休克而无出血证据，应进行甲状腺功能检查以排除甲状腺危象。此外，如果在创伤患者中观察到甲状腺功能亢进，即使没有甲状腺功能亢进的病史，也必须考虑甲状腺危象的可能性，并在患者出现心源性休克时给予 ECMO 等支持治疗。
