伴有未确诊格雷夫斯病的阑尾炎破裂：造影剂诱发的甲状腺危象先兆
Ruptured appendicitis with undiagnosed Graves' disease: Contrast-induced impending thyroid storm.
作者信息
Sungworawongpana Chutida, Chaochankit Wongsakorn
机构信息
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
出版信息
Ann Med Surg (Lond). 2022 Sep 9;82:104600. doi: 10.1016/j.amsu.2022.104600. eCollection 2022 Oct.
BACKGROUND
Thyrotoxicosis is a generally common endocrine condition. Widespread radiologic studies and interventional treatments can increase the prevalence of contrast-induced thyrotoxicosis.
CASE PRESENTATION
A younger Thai female was diagnosed acute appendicitis that underwent computed tomography of abdomen with contrast injection. After the operation, she had fever and tachycardia without source of infection, but her thyroid function test showed hyperthyroidism, so she was diagnosed graves' disease and received the treatment without thyroid storm.
DISCUSSION
Graves' disease is the most prevalent cause of hyperthyroidism in women but there are many causes of hyperthyroidism especially contrast-induced hyperthyroidism in this care, so the necessary of diagnostic tools especially contrast computed tomography should be carefully used in some patients.
CONCLUSION
Critical radiologic studies and interventional procedures can increase the prevalence of contrast-induced thyrotoxicosis, particularly in high-risk patients. Utilizing a multidisciplinary team, clinicians must promptly address thyrotoxicosis and avert the thyroid storm.
背景
甲状腺毒症是一种普遍常见的内分泌疾病。广泛的放射学检查和介入治疗会增加对比剂诱导的甲状腺毒症的患病率。
病例介绍
一名年轻的泰国女性被诊断为急性阑尾炎，接受了腹部增强计算机断层扫描。术后，她出现发热和心动过速，未发现感染源，但甲状腺功能检查显示甲状腺功能亢进，因此被诊断为格雷夫斯病，并在未发生甲状腺危象的情况下接受了治疗。
讨论
格雷夫斯病是女性甲状腺功能亢进最常见的原因，但甲状腺功能亢进有许多原因，尤其是在本病例中对比剂诱导的甲状腺功能亢进，因此在某些患者中应谨慎使用必要的诊断工具，尤其是增强计算机断层扫描。
结论
关键的放射学检查和介入操作会增加对比剂诱导的甲状腺毒症的患病率，尤其是在高危患者中。临床医生必须利用多学科团队及时处理甲状腺毒症并避免甲状腺危象。
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