以上消化道出血为首发表现的甲状腺危象合并Evans综合征一例并文献复习  

Thyroid storm associated with Evans syndrome with upper gastrointestinal bleeding as the first manifestation:a case report and literature review

作　　者：董小荣[1] 马晓轩 郑晓娟 任巧兰 金喜胜 马莉[1] Dong Xiaorong;Ma Xiaoxuan;Zheng Xiaojuan;Ren Qiaolan;Jin Xisheng;Ma Li(Department of Critical Care Medicine,Lanzhou University Second Hospital,Lanzhou 733030,China;Department of Critical Care Medicine,Jiayuguan First People’s Hospital,Jiayuguan 735100,China;Department of Critical Care Medicine,Wuwei People’s Hospital,Wuwei 733000,China)

机构地区：[1]兰州大学第二医院重症医学科,兰州733030 [2]嘉峪关市第一人民医院重症医学科,甘肃嘉峪关735100 [3]武威市人民医院重症医学科,甘肃武威733000

出　　处：《中华重症医学电子杂志》2024年第3期303-309,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：甲状腺危象是一种威胁生命的疾病,需要快速诊断和紧急治疗,是格雷夫斯病(GD)未经治疗或治疗不足的一种并发症。以上消化道出血为首发表现,既往无甲状腺功能病史,且合并Evans综合征(ES)在临床中罕见。本文报告1例以上消化道出血为首发表现的甲状腺危象患者,入院后出现肝损伤、急性肾衰竭、意识障碍、急性呼吸衰竭、循环衰竭、癫痫、休克等并发症,很快确诊甲状腺危象,首次确诊GD,抗甲状腺药物治疗过程中出现血红蛋白(Hb)和血小板下降,行相关检查后,考虑ES,给予糖皮质激素及静脉注射用丙种球蛋白治疗,Hb和血小板逐渐上升。出院后继续口服甲巯咪唑和甲泼尼龙,每半月定期复查,目前肾功能和血小板正常,Hb处于上升阶段。本病例提示GD可以有很多不同临床表现,甲状腺危象是其极端的临床表现之一,诊断具有挑战性,合并ES,不仅仅是巧合,两者均属于自身免疫性疾病,甲巯咪唑联合甲泼尼龙、免疫球蛋白治疗,可使得患者Hb及血小板好转,病情恢复。Thyroid storm is a life-threatening condition that requires rapid diagnosis and urgent treatment,and it is a complication of Graves’disease(GD)that is untreated or insufficiently treated.Upper gastrointestinal bleeding is the first manifestation,and there is no previous history of thyroid function,and Evans syndrome(ES)is a rare clinical complication.This paper reported a patient with thyroid storm with upper gastrointestinal hemorrhage as the first manifestation.After admission,his complication such as liver injury,acute renal failure,disturbance of consciousness,acute respiratory failure,circulatory failure,epilepsy and shock occurred.Thyroid storm was quickly diagnosed and GD was diagnosed for the first time.During the treatment with anti-thyroid drugs,there was a decrease in hemoglobin(Hb)and platelets.After relevant examinations,ES was considerd.After treatment with Glucocorticoid and intravenous Gamma globulin,Hb and platelets gradually increased.After discharge,he continued to take Thiamazole and Methylprednisolone orally,and took regular reexamination every half month.At present,his kidney function and platelets were normal,and Hb was in the rising stage.This case suggests that GD can have many different clinical manifestations,thyroid storm is extrem clinical manifestation,and the diagnosis is challenging.The combination of ES is not a coincidence,as both of them are autoimmune diseases.The treatment of Thiamazole combined with Methylprednisolone and immunoglobulin can improve the patient’s Hb and platelet and recover the condition.

关 键 词：上消化道出血 甲状腺危象 格雷夫斯病 EVANS综合征 

分 类 号：R581[医药卫生—内分泌]