Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Cardiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India.
BMJ Case Rep. 2022 Aug 26;15(8):e250488. doi: 10.1136/bcr-2022-250488.
We present a case of thyroid storm precipitated by discontinuation of antithyroid drugs. The patient developed a concurrent acute coronary event during the resolution period of the thyroid storm. After 48 hours of prudent management of thyroid storm, the patient's sensorium and haemodynamics were stabilised but he had persistent mild chest discomfort and developed new-onset jaw pain. On admission, ECG showed sinus tachycardia. In consideration of persistent mild chest discomfort and new-onset jaw pain, serial ECGs were performed which revealed biphasic T waves in V2-V3 suggestive of Wellens' syndrome type A. This indicated a critical stenosis of the left anterior descending (LAD) coronary artery and impending myocardial ischaemia. The patient underwent urgent coronary catheterisation, which revealed 80% stenosis of proximal LAD and was subsequently revascularised resolving his symptoms. This case underscores the significance of serial ECG monitoring even after the acute phase of thyroid crisis, which helped in timely identification of Wellens' syndrome.
我们报告了一例由抗甲状腺药物停药引发的甲状腺危象病例。在甲状腺危象缓解期间，该患者并发急性冠状动脉事件。经过 48 小时的甲状腺危象谨慎治疗后，患者的意识和血液动力学得到稳定，但仍持续轻度胸痛，并出现新的颌痛。入院时，心电图显示窦性心动过速。考虑到持续轻度胸痛和新出现的颌痛，连续进行了心电图检查，V2-V3 导联出现双向 T 波，提示 Wellens 综合征 A 型。这表明左前降支（LAD）冠状动脉严重狭窄，即将发生心肌缺血。患者接受紧急冠状动脉造影，显示近端 LAD 狭窄 80%，随后进行血运重建，症状得到缓解。本例强调了即使在甲状腺危象的急性期过后，仍需要进行连续心电图监测的重要性，这有助于及时发现 Wellens 综合征。
