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Accidente cerebrovascular cardioembólico recurrente fatal relacionado con tormenta tiroidea: reporte de un caso
Chu-Fang Cheng1, Chih-Yang Liu1, Shinn-Kuang Lin1,2
1Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
Acta neurologica Taiwanica
|December 30, 2025
Resumen
La tormenta tiroidea, una complicación grave del hipertiroidismo, puede simular síntomas de accidente cerebrovascular. El diagnóstico temprano y el tratamiento simultáneo de la tormenta tiroidea y el accidente cerebrovascular isquémico son críticos pero desafiantes, como lo ilustra un caso complejo.
Área de la Ciencia:
- Endocrinología
- Neurología
- Cardiología
Sus antecedentes:
- La tormenta tiroidea es una emergencia endocrina rara y potencialmente mortal.
- El hipertiroidismo puede presentarse con complicaciones neurológicas y cardiovasculares.
- Distinguir la tormenta tiroidea de un accidente cerebrovascular agudo es clínicamente desafiante.
Objetivo del estudio:
- Reportar un caso de tormenta tiroidea que se presenta con síntomas similares a los de un accidente cerebrovascular.
- Destacar los desafíos diagnósticos y terapéuticos en el manejo de la tormenta tiroidea y el accidente cerebrovascular isquémico coexistentes.
- Enfatizar la importancia del diagnóstico temprano y el manejo integrado.
Principales métodos:
- Reporte de caso de una mujer de 50 años con antecedentes de hipertiroidismo y fibrilación auricular.
- Presentación clínica de debilidad aguda en la extremidad izquierda y habla arrastrada.
- Estudio diagnóstico que incluye ECG, radiografía de tórax, angiotomografía cerebral, pruebas de laboratorio (hormonas tiroideas, anticuerpo del receptor de TSH) y ecocardiografía.
- El manejo incluyó terapia trombolítica, digoxina, propranolol y propiltiouracilo.
Principales resultados:
- La paciente presentó síntomas que simulaban un accidente cerebrovascular isquémico.
- Los hallazgos de laboratorio confirmaron tormenta tiroidea (FT4, FT3 elevadas; TSH reducida; anticuerpo del receptor de TSH positivo).
- A pesar de la terapia trombolítica inicial y el manejo posterior, la paciente desarrolló infarto recurrente bilateral del hemisferio, lo que provocó coma y cuadriplejia.
Conclusiones:
- La tormenta tiroidea puede presentarse con déficits neurológicos que imitan un accidente cerebrovascular isquémico agudo.
- El manejo simultáneo de la tormenta tiroidea y el accidente cerebrovascular isquémico plantea importantes desafíos clínicos.
- El diagnóstico rápido y las estrategias terapéuticas integradas son cruciales para mejorar los resultados en pacientes con afecciones coexistentes.
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