甲亢危象并发多器官衰竭1例报告  

Hyperthyroid crisis with multiple organ failure:a case report

作　　者：熊道学[1] 罗玉琳[2] 姜建渝[1] 冯琰[1] 成艳[1] XIONG Daoxue;LUO Yulin;JIANG Jianyu;FENG Yan;CHENG Yan(Department of Pediatric Intensive Medicine,Chongqing Three Gorges Central Hospital;Chongqing Three Gorges Medical College,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院儿童重症医学科 [2]重庆三峡医药高等专科学校,重庆404000

出　　处：《临床儿科杂志》2020年第4期281-284,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童甲亢危象的临床特征。方法回顾分析1例甲亢危象并发多器官衰竭患儿的临床资料。结果女性患儿,13岁,既往无甲状腺疾病史。患儿以恶心、呕吐、神萎起病,入院时以心律失常、心源性休克、心力衰竭为主要表现,考虑为暴发性心肌炎。有轻度突眼。游离T3、游离T4明显增高,促甲状腺激素明显降低。入院后相继出现呼吸衰竭、肾衰竭及肝衰竭,甲亢危象评分120分,确诊为甲亢危象。经积极抗心律失常、应用血管活性药物、呼吸支持、丙硫氧嘧啶、碘剂、糖皮质激素、血液净化等综合治疗,患儿好转出院。结论甲亢危象在儿童较为罕见,但可以作为儿童甲状腺疾病的首发症状出现。甲亢危象表现隐匿,早期识别、及早综合治疗是治疗成功的关键。Objective To explore the clinical characteristics of hyperthyroidism crisis in children.Method The clinical data of hyperthyroid crisis complicated with multiple organ failure in a child was analyzed retrospectively.Results A 13-year-old girl had no history of thyroid disease.The initial symptoms included nausea,vomiting and lethargy,and the main manifestations at admission included arrhythmia,cardiogenic shock,and heart failure,so it was considered as fulminant myocarditis.Physical examination at admission revealed mild exophthalmos,and thyroid function test revealed significantly increased free T3(FT3)and free T4(FT4)and significantly decreased thyroid stimulating hormone(TSH).After admission,the patient successively developed respiratory failure,renal failure,and hepatic failure.The thyroid storm score was 120 points and accordingly the diagnosis of thyroid storm was confirmed.After treated with active antiarrhythmic treatment,vasoactive agents,respiratory support,propylthiouracil,iodine,glucocorticoids,and blood purification,etc.,the patient was eventually discharged with improved condition.Conclusions Thyroid storm is a rare condition in children.It can have thyroid diseases as its initial presentation in children.Early identification and management are the keys to successful treatment.

关 键 词：甲亢危象 多器官衰竭 暴发性心肌炎 

分 类 号：R720.597[医药卫生—急诊医学] R725.8[医药卫生—儿科]