Barnett Maxim John Levy, Casipit Carlo, Sathi Sri Ram Teja, Rodriguez Ana Del Carmen Rivadeneira
Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA.
Endocrinol Diabetes Metab Case Rep. 2024 Sep 4;2024(3). doi: 10.1530/EDM-24-0067. Print 2024 Jul 1.
Thyroid storm is a clinical diagnosis characterized by life-threatening multisystemic organ involvement in the setting of uncontrolled hyperthyroidism. Current estimates suggest a mortality rate of up to 30%. Treatment often consists of the administration of thionamide medications, iodine solution(s), corticosteroids, and beta-blockers; in extreme circumstances, both plasmapheresis and thyroidectomy are subsequent therapeutic options. Thionamides are typically administered orally, with the intent of preventing further thyroid hormone synthesis; however, in the literature, there are instances whereby oral access cannot be obtained, and alternative routes of administration are required. We present a case of a patient who presented with a thyroid storm due to lack of adherence to methimazole. During admission, he was found to have significant abdominal pain and ultimately a duodenal perforation requiring strict nil-per-os (NPO) status, due to which he was unable to receive oral thionamides. Due to the lack of availability of intravenous formulations of thionamides in the United States, this patient was treated with an enema compound of propylthiouracil for a total of five per rectum (PR) doses. He would later develop hepatocellular injury, requiring discontinuation and eventual transition to oral methimazole. The literature pertaining to alternative-route thionamide administration is scant, and therefore this case report and literature review is written to provide an up-to-date review and further educate all levels of clinicians about this infrequent (but emergent) situation.
Thyroid storm is a clinical diagnosis for which urgent recognition is required to prevent untoward mortality. Treatment for thyroid storm requires prompt administration of thionamides, iodine, corticosteroids, and beta-blockers. In extreme circumstances, treatment considerations include plasmapheresis and thyroidectomy. Infrequently, patients with a thyroid storm may not be able to tolerate oral medications, for which alternative routes of access are required. Currently, available alternatives include intravenous methimazole (in Europe and Japan), as well as both enema and suppository preparations of propylthiouracil and methimazole.
甲状腺危象是一种临床诊断，其特征为在未控制的甲状腺功能亢进情况下出现危及生命的多系统器官受累。目前的估计表明死亡率高达30%。治疗通常包括给予硫代酰胺类药物、碘溶液、皮质类固醇和β受体阻滞剂；在极端情况下，血浆置换和甲状腺切除术是后续的治疗选择。硫代酰胺类药物通常口服给药，目的是防止进一步合成甲状腺激素；然而，在文献中，存在无法获得口服途径且需要替代给药途径的情况。我们报告一例因未坚持服用甲巯咪唑而出现甲状腺危象的患者。入院期间，他被发现有严重腹痛，最终出现十二指肠穿孔，需要严格禁食（NPO），因此无法口服硫代酰胺类药物。由于美国没有硫代酰胺类药物的静脉制剂，该患者接受了丙硫氧嘧啶灌肠剂治疗，共直肠给药5次。他后来出现肝细胞损伤，需要停药并最终改用口服甲巯咪唑。关于硫代酰胺类药物替代途径给药的文献很少，因此撰写本病例报告和文献综述是为了提供最新的综述，并进一步教育各级临床医生了解这种罕见（但紧急）的情况。
甲状腺危象是一种临床诊断，需要紧急识别以防止不良死亡率。甲状腺危象的治疗需要迅速给予硫代酰胺类药物、碘、皮质类固醇和β受体阻滞剂。在极端情况下，治疗考虑包括血浆置换和甲状腺切除术。很少有甲状腺危象患者可能无法耐受口服药物，为此需要替代给药途径。目前，可用的替代方法包括静脉注射甲巯咪唑（在欧洲和日本），以及丙硫氧嘧啶和甲巯咪唑的灌肠剂和栓剂制剂。
