Alkwatli Kenda, Azmath Misbah, Grover Prashant, Luthra Pooja
Cleveland Clinic Foundation, Division of Endocrinology, Diabetes, and Metabolism, Cleveland, OH 44106, USA.
Division of Endocrinology, Diabetes and Metabolism, University of Connecticut School of Medicine, Farmington, CT 06032, USA.
JCEM Case Rep. 2023 Aug 2;1(4):luad053. doi: 10.1210/jcemcr/luad053. eCollection 2023 Jul.
Thyroid storm is a life-threatening endocrine emergency that warrants early clinical recognition and aggressive intervention. We present a 64-year-old female with no known history of thyroid disease, who presented to her primary care physician with dyspnea on exertion and was found to have an anterior mediastinal mass. She had elective thymectomy. Pathology confirmed thymic lymphoepithelial carcinoma. Postoperatively, she developed altered mental status, fever, and atrial fibrillation with marked elevation of thyroid hormones, consistent with thyroid storm. She decompensated rapidly and was treated aggressively with standard therapies for thyroid storm, including beta-blockers, methimazole, cholestyramine, steroids, and iodine, with poor response. The patient eventually underwent 4 sessions of therapeutic plasma exchange (TPE) with marked improvement in her symptoms. This case reports a possible association between thymic lymphoepithelial carcinoma and Graves disease and highlights the utility of TPE in cases of severe thyroid storm that are refractory to traditional treatments. We learn from this case that evaluating thyroid function tests in patients with thymic or mediastinal masses before surgery might be helpful. TPE should be considered in patients with thyroid storm refractory to traditional therapies.
甲状腺危象是一种危及生命的内分泌急症，需要早期临床识别和积极干预。我们报告一例64岁女性，既往无甲状腺疾病史，因劳力性呼吸困难就诊于其初级保健医生，发现有前纵隔肿块。她接受了择期胸腺切除术。病理证实为胸腺淋巴上皮癌。术后，她出现精神状态改变、发热和房颤，甲状腺激素显著升高，符合甲状腺危象。她迅速失代偿，接受了甲状腺危象的标准治疗，包括β受体阻滞剂、甲巯咪唑、考来烯胺、类固醇和碘，反应不佳。患者最终接受了4次治疗性血浆置换（TPE），症状明显改善。本病例报告了胸腺淋巴上皮癌与格雷夫斯病之间可能的关联，并强调了TPE在传统治疗难治的严重甲状腺危象病例中的作用。我们从此病例中了解到，术前对胸腺或纵隔肿块患者进行甲状腺功能检查可能会有所帮助。对于传统疗法难治的甲状腺危象患者，应考虑进行TPE。
