BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only re...BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.展开更多
BACKGROUND Thyroid storm is a life-threatening emergency.Reportedly,the prevalence of thyroid storm is 1%-2%among patients admitted to the hospital for thyrotoxicosis.Burch and Wartofsky(1993)introduced a scoring syst...BACKGROUND Thyroid storm is a life-threatening emergency.Reportedly,the prevalence of thyroid storm is 1%-2%among patients admitted to the hospital for thyrotoxicosis.Burch and Wartofsky(1993)introduced a scoring system using precise clinical criteria to identify thyroid storms.Only 17 cases of thyroid storm with a score>70 points have been reported.Although thyroid storms are uncommon,their clinical findings resemble those of sepsis.CASE SUMMARY A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation;medications for hypertension,diabetes mellitus,and hyperthyroidism had been suspended 1 year prior to this visit.We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation,and the patient was referred to the surgical intensive care unit(ICU).On the 2nd d in the ICU,his body temperature(BT)increased to 41.3℃ at 19:00,with the thyroid storm score(90 points)peaking at 18:00(BT;41.2℃,pulse rate;138/min,irritable status).The patient was administered propylthiouracil,intravenous glucocorticoids,acetaminophen,and Lugol’s solution daily.Subsequently,we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT.His vital signs were stable on the 8th day in the ICU.CONCLUSION Thyroid storms are uncommon,with few reports in the literature;however,their clinical findings resemble those of sepsis and require further investigation.Since an untreated thyroid storm results in a high mortality rate,it should be investigated when managing sepsis.展开更多
BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of bot...BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways.We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.CASE SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day duration.Further history revealed weight loss,diarrhea,and anxiety over the past three months.On clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/50mmHg.His abdomen was tender with generalized peritonism.In view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/mL.Chest X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid.The working diagnosis was perforated peptic ulcer complicated by thyroid storm.An urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids pre-operatively.The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer.Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine.Histology of the ulcer edges showed no malignancy.On post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/L.His thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/L.Patient’s recovery was otherwise uneventful.Thyroid receptor antibody subsequently was positive,and patient was managed for Grave’s disease by the endocrinologist.CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm.Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.展开更多
BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effectiv...BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effective treatment for thyroid storm with severe liver injury.CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa.Further,her free T3(FT3)and FT4 levels were significantly elevated,whereas her thyrotropin level was reduced.After admission,her condition continued to deteriorate,and she presented with continued high fever,vomiting,palpitation,and shortness of breath.After being diagnosed with thyroid storm,the patient was immediately treated with PE combined with DPMAS.Her symptoms improved immediately.After three PE+DPMAS treatments,and she was discharged from the hospital.She was treated with methylprednisolone and methylthimidazole.After six months,the patient spontaneously discontinued methylthimidazole treatment.Her previous clinical manifestations and liver dysfunction reoccurred.The patient was treated with PE+DPMAS two times,and her condition rapidly improved.Liver histopathology indicated immunological liver injury.CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.展开更多
甲亢危象是一种罕见的、危及生命的内分泌急症,患者有严重的甲状腺毒症临床表现。美国和日本的研究显示,甲亢危象的年发病率分别为(0.57~0.76)/10万和0.2/10万。甲亢危象占甲状腺毒症患者的0.22%,占住院甲状腺毒症患者的5.4%。即使在获...甲亢危象是一种罕见的、危及生命的内分泌急症,患者有严重的甲状腺毒症临床表现。美国和日本的研究显示,甲亢危象的年发病率分别为(0.57~0.76)/10万和0.2/10万。甲亢危象占甲状腺毒症患者的0.22%,占住院甲状腺毒症患者的5.4%。即使在获得及时治疗的情况下,甲亢危象患者的死亡率仍高达10%~30%;若未治疗,则患者的死亡率可达90%。甲亢危象的急诊漏诊和误诊率高达43.48%。导致甲亢危象的诱因可能包括突然停用抗甲状腺药物或急性事件(如感染、创伤、甲状腺或非甲状腺手术、急性碘负荷或分娩)以及其他少见的病因。目前尚无公认的标准或临床工具用于诊断甲亢危象,其诊断依据包括存在甲亢的生化证据(游离T4或T3升高、TSH降低),以及危及生命的严重症状(高热、心血管功能障碍及精神状态改变等)。伯奇-沃托斯基点量表(Burch-Wartofsky point scale,BWPS)近30年来一直被广泛应用于甲亢危象的诊断。甲亢危象的主要治疗包括一般对症治疗及针对甲状腺的特异性治疗,包括去除诱因和治疗并发症,如使用抗甲状腺药物、碘剂、糖皮质激素及β受体阻滞剂等抑制甲状腺激素合成,或阻断外周T4向T3转换或抑制甲状腺激素释放,对上述治疗后病情改善不明显者,则可以尝试血液净化(血浆置换)治疗。此外,支持治疗对于甲亢危象患者亦至关重要。甲亢危象患者经过积极治疗,病情多在1~2d内改善。甲亢危象抢救成功后,应采用根治方法治疗甲亢。展开更多
BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease...BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.展开更多
文摘BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.
文摘BACKGROUND Thyroid storm is a life-threatening emergency.Reportedly,the prevalence of thyroid storm is 1%-2%among patients admitted to the hospital for thyrotoxicosis.Burch and Wartofsky(1993)introduced a scoring system using precise clinical criteria to identify thyroid storms.Only 17 cases of thyroid storm with a score>70 points have been reported.Although thyroid storms are uncommon,their clinical findings resemble those of sepsis.CASE SUMMARY A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation;medications for hypertension,diabetes mellitus,and hyperthyroidism had been suspended 1 year prior to this visit.We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation,and the patient was referred to the surgical intensive care unit(ICU).On the 2nd d in the ICU,his body temperature(BT)increased to 41.3℃ at 19:00,with the thyroid storm score(90 points)peaking at 18:00(BT;41.2℃,pulse rate;138/min,irritable status).The patient was administered propylthiouracil,intravenous glucocorticoids,acetaminophen,and Lugol’s solution daily.Subsequently,we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT.His vital signs were stable on the 8th day in the ICU.CONCLUSION Thyroid storms are uncommon,with few reports in the literature;however,their clinical findings resemble those of sepsis and require further investigation.Since an untreated thyroid storm results in a high mortality rate,it should be investigated when managing sepsis.
文摘BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways.We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.CASE SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day duration.Further history revealed weight loss,diarrhea,and anxiety over the past three months.On clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/50mmHg.His abdomen was tender with generalized peritonism.In view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/mL.Chest X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid.The working diagnosis was perforated peptic ulcer complicated by thyroid storm.An urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids pre-operatively.The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer.Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine.Histology of the ulcer edges showed no malignancy.On post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/L.His thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/L.Patient’s recovery was otherwise uneventful.Thyroid receptor antibody subsequently was positive,and patient was managed for Grave’s disease by the endocrinologist.CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm.Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.
文摘BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effective treatment for thyroid storm with severe liver injury.CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa.Further,her free T3(FT3)and FT4 levels were significantly elevated,whereas her thyrotropin level was reduced.After admission,her condition continued to deteriorate,and she presented with continued high fever,vomiting,palpitation,and shortness of breath.After being diagnosed with thyroid storm,the patient was immediately treated with PE combined with DPMAS.Her symptoms improved immediately.After three PE+DPMAS treatments,and she was discharged from the hospital.She was treated with methylprednisolone and methylthimidazole.After six months,the patient spontaneously discontinued methylthimidazole treatment.Her previous clinical manifestations and liver dysfunction reoccurred.The patient was treated with PE+DPMAS two times,and her condition rapidly improved.Liver histopathology indicated immunological liver injury.CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.
文摘甲亢危象是一种罕见的、危及生命的内分泌急症,患者有严重的甲状腺毒症临床表现。美国和日本的研究显示,甲亢危象的年发病率分别为(0.57~0.76)/10万和0.2/10万。甲亢危象占甲状腺毒症患者的0.22%,占住院甲状腺毒症患者的5.4%。即使在获得及时治疗的情况下,甲亢危象患者的死亡率仍高达10%~30%;若未治疗,则患者的死亡率可达90%。甲亢危象的急诊漏诊和误诊率高达43.48%。导致甲亢危象的诱因可能包括突然停用抗甲状腺药物或急性事件(如感染、创伤、甲状腺或非甲状腺手术、急性碘负荷或分娩)以及其他少见的病因。目前尚无公认的标准或临床工具用于诊断甲亢危象,其诊断依据包括存在甲亢的生化证据(游离T4或T3升高、TSH降低),以及危及生命的严重症状(高热、心血管功能障碍及精神状态改变等)。伯奇-沃托斯基点量表(Burch-Wartofsky point scale,BWPS)近30年来一直被广泛应用于甲亢危象的诊断。甲亢危象的主要治疗包括一般对症治疗及针对甲状腺的特异性治疗,包括去除诱因和治疗并发症,如使用抗甲状腺药物、碘剂、糖皮质激素及β受体阻滞剂等抑制甲状腺激素合成,或阻断外周T4向T3转换或抑制甲状腺激素释放,对上述治疗后病情改善不明显者,则可以尝试血液净化(血浆置换)治疗。此外,支持治疗对于甲亢危象患者亦至关重要。甲亢危象患者经过积极治疗,病情多在1~2d内改善。甲亢危象抢救成功后,应采用根治方法治疗甲亢。
文摘BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.
