Medenica Sanja, Prelević Vladimir, Tomovic Filip, Jha Vivek, Laketić Nenad, Bajčeta Nataša, Stojković Mirjana, Dutta Pinaki
Endocrinol Diabetes Metab Case Rep. 2025 May 10;2025(2). doi: 10.1530/EDM-24-0150. Print 2025 Apr 1.
A 67-year-old Caucasian woman with a history of Graves' disease and atrial fibrillation presented with severe symptoms indicative of an impending thyroid storm, including diarrhea, tremors, palpitations and significant weight loss. Initially treated with methimazole, she was switched to propylthiouracil (PTU) due to an allergic reaction but had to discontinue PTU after developing agranulocytosis. Laboratory tests confirmed suppressed thyroid-stimulating hormone and elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels, alongside neutropenia. The medical team administered high-dose intravenous steroids and granulocyte colony-stimulating factor (G-CSF) in response to her worsening condition and to mitigate infection risk. Despite these measures, her thyroid hormone levels remained high, necessitating therapeutic plasma exchange (TPE). This intervention significantly reduced her thyroid hormone levels and thyrotropin receptor antibodies (TRAb), stabilizing her condition. Post-TPE, she underwent successful radioactive iodine therapy (RAI), which led to a gradual return to euthyroid status and substantial symptomatic relief. Three months post-RAI, she maintained a stable euthyroid state with normalized neutrophil counts, demonstrating the effectiveness of a multidisciplinary approach in managing impending thyroid storm complications. This case highlights the importance of timely and integrated therapeutic interventions in managing life-threatening endocrine emergencies.
This case highlights the importance of early recognition and management of agranulocytosis induced by antithyroid drugs, particularly in the context of Graves' disease. Therapeutic plasma exchange (TPE) can be an effective bridging therapy for rapid thyroid hormone reduction in thyroid storm, especially when conventional treatments are insufficient or contraindicated. Quick and effective intervention is essential in managing thyroid storm to prevent systemic decompensation, highlighting the importance of a timely and coordinated treatment approach. The role of TPE in managing severe hyperthyroidism underscores the need for flexibility and innovation in critical endocrine emergencies.
一名67岁的白种女性，有格雷夫斯病和心房颤动病史，出现了严重症状，提示即将发生甲状腺危象，包括腹泻、震颤、心悸和显著体重减轻。最初用甲巯咪唑治疗，因过敏反应改用丙硫氧嘧啶（PTU），但在发生粒细胞缺乏症后不得不停用PTU。实验室检查证实促甲状腺激素被抑制，游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）水平升高，同时伴有中性粒细胞减少。医疗团队针对她不断恶化的病情给予高剂量静脉注射类固醇和粒细胞集落刺激因子（G-CSF），以降低感染风险。尽管采取了这些措施，她的甲状腺激素水平仍然很高，需要进行治疗性血浆置换（TPE）。这项干预措施显著降低了她的甲状腺激素水平和促甲状腺素受体抗体（TRAb），使她的病情稳定下来。TPE后，她成功接受了放射性碘治疗（RAI），逐渐恢复到甲状腺功能正常状态，并显著缓解了症状。RAI后三个月，她维持了稳定的甲状腺功能正常状态，中性粒细胞计数正常，证明了多学科方法在处理即将发生的甲状腺危象并发症方面的有效性。本病例强调了及时和综合治疗干预在处理危及生命的内分泌急症中的重要性。
本病例强调了早期识别和处理抗甲状腺药物引起的粒细胞缺乏症的重要性，特别是在格雷夫斯病的背景下。治疗性血浆置换（TPE）可以作为一种有效的过渡治疗，用于在甲状腺危象中快速降低甲状腺激素水平，特别是在传统治疗不足或禁忌时。在处理甲状腺危象时，快速有效的干预对于防止全身失代偿至关重要，突出了及时和协调治疗方法的重要性。TPE在处理严重甲亢中的作用强调了在危急内分泌急症中灵活性和创新性的必要性。
