甲状腺风暴时直肠服用硫酰胺:病例报告和文献综述。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Maxim John Levy Barnett, Carlo Casipit, Sri Ram Teja Sathi, Ana Del Carmen Rivadeneira Rodriguez
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引用次数: 0

摘要

摘要:甲状腺风暴是一种临床诊断,其特点是在甲状腺功能亢进症未得到控制的情况下,多系统器官受累,危及生命。目前估计死亡率高达 30%。治疗通常包括应用硫代酰胺类药物、碘溶液、皮质类固醇和β-受体阻滞剂;在极端情况下,浆细胞吸出术和甲状腺切除术都是随后的治疗选择。硫酰胺类药物通常通过口服给药,目的是阻止甲状腺激素的进一步合成;但在文献中,也有无法通过口服给药而需要采用其他给药途径的病例。我们介绍了一例因未坚持服用甲巯咪唑而出现甲状腺风暴的患者。在入院时,他被发现有明显的腹痛,并最终导致十二指肠穿孔,需要严格的禁食(NPO)状态,因此无法口服硫酰胺类药物。由于美国没有硫代酰胺类药物的静脉注射剂型,该患者接受了丙基硫氧嘧啶灌肠剂治疗,共使用了五次直肠(PR)剂量。后来他出现了肝细胞损伤,需要停药并最终转为口服甲巯咪唑。有关替代途径硫酰胺给药的文献很少,因此撰写本病例报告和文献综述的目的是提供最新的综述,并进一步向各级临床医生介绍这种并不常见(但却很紧急)的情况:学习要点:甲状腺风暴是一种需要紧急识别的临床诊断,以防止意外死亡。治疗甲状腺风暴需要及时使用硫酰胺类药物、碘、皮质类固醇和β-受体阻滞剂。在极端情况下,治疗方法包括浆细胞吸出术和甲状腺切除术。有时,甲状腺风暴患者可能无法耐受口服药物,这就需要通过其他途径进行治疗。目前,可用的替代药物包括静脉注射甲巯咪唑(在欧洲和日本),以及丙基硫氧嘧啶和甲巯咪唑的灌肠剂和栓剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rectal thionamide administration in the setting of thyroid storm: a case report and review of the literature.

Summary: Thyroid storm is a clinical diagnosis characterized by life-threatening multisystemic organ involvement in the setting of uncontrolled hyperthyroidism. Current estimates suggest a mortality rate of up to 30%. Treatment often consists of the administration of thionamide medications, iodine solution(s), corticosteroids, and beta-blockers; in extreme circumstances, both plasmapheresis and thyroidectomy are subsequent therapeutic options. Thionamides are typically administered orally, with the intent of preventing further thyroid hormone synthesis; however, in the literature, there are instances whereby oral access cannot be obtained, and alternative routes of administration are required. We present a case of a patient who presented with a thyroid storm due to lack of adherence to methimazole. During admission, he was found to have significant abdominal pain and ultimately a duodenal perforation requiring strict nil-per-os (NPO) status, due to which he was unable to receive oral thionamides. Due to the lack of availability of intravenous formulations of thionamides in the United States, this patient was treated with an enema compound of propylthiouracil for a total of five per rectum (PR) doses. He would later develop hepatocellular injury, requiring discontinuation and eventual transition to oral methimazole. The literature pertaining to alternative-route thionamide administration is scant, and therefore this case report and literature review is written to provide an up-to-date review and further educate all levels of clinicians about this infrequent (but emergent) situation.

Learning points: Thyroid storm is a clinical diagnosis for which urgent recognition is required to prevent untoward mortality. Treatment for thyroid storm requires prompt administration of thionamides, iodine, corticosteroids, and beta-blockers. In extreme circumstances, treatment considerations include plasmapheresis and thyroidectomy. Infrequently, patients with a thyroid storm may not be able to tolerate oral medications, for which alternative routes of access are required. Currently, available alternatives include intravenous methimazole (in Europe and Japan), as well as both enema and suppository preparations of propylthiouracil and methimazole.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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