摘要

BACKGROUND:Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS.
PATIENT FINDINGS:A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL).
SUMMARY:Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state.
CONCLUSIONS:The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably a life-saving treatment in patients who are exposed to amounts of thyroid hormone far in excess of that usually produced by the thyroid gland.

译文

背景: 甲状腺风暴 (TS) 是一种罕见的危及生命的疾病，其特征是由内源性或外源性危急事件、疾病/损伤、急性碘负荷、和甲状腺或非甲状腺手术。大量的甲状腺提取物可供选择并广泛使用，即使临床上不推荐用于甲状腺功能减退或甲状腺功能正常的患者。消费这种产品可能是危险的，并导致危及生命的 TS。在这里，我们报告了一个由在复合甲状腺提取物中意外摄入非常高剂量的三碘甲状腺原氨酸 (T3) 和甲状腺素 (T4) 引起的 TS 病例。血浆置换可能被认为是治疗外源性 TS 的一种选择。
患者发现: 一名 62 岁的女性，没有明显的病史，表现为严重肌痛、发烧、心动过速和血压 170/80 汞柱, 在 24 小时内促成改变的精神状态。神经系统检查没有发现任何病灶缺失或脑膜刺激的迹象。进一步的调查显示，她一直在服用甲状腺补充剂。意外地向患者提供了一批甲状腺提取物药丸，这些药丸无意中含有高 t4 含量。她的游离 T3 (FT3) 和游离 T4 (FT4) 水平被发现非常高，超出了实验室的可读范围 (FT3> 30 皮克/毫升; FT4> 6.06 纳克/升; 促甲状腺激素 [TSH] = 0.07 IU/mL)。
总结: TS 标准保守治疗开始后三天，患者出现可逆性后部脑病综合征，导致癫痫发作。她仍然没有反应，精神状态也很差。证实的 TS 的外源性病因导致了进行血浆置换的决定。连续两天进行的血浆置换被证明是治疗 TS 的一种成功措施，并改善了她的甲状腺状况和精神状态。
结论: 甲状腺功能正常和甲状腺功能减退患者不适当使用甲状腺提取物会导致危及生命的 TS。血浆置换术可能是一种拯救生命的治疗方法，用于那些接触到远远超过通常由甲状腺产生的甲状腺激素量的患者。