在甲状腺毒性危机中进行甲状腺切除术:甲状腺安全状态是必要的吗? 一个案例系列
Guillermo Guzmán1, Andres O Garcia1, Oriana A Valderrama2,3
1Departamento de Medicina Interna, Endocrinología, Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali 760032, Colombia.
Journal of surgical case reports
|October 2, 2025
概括
早期甲状腺切除术是当医疗治疗失败时严重的甲状腺毒性危机的安全选择. 在手术前专注于心率控制是关键,而不是等待正常的甲状腺水平.
科学领域:
- 内分泌学 在内分泌学.
- 手术重症监护手术重症监护
背景情况:
- 甲状腺毒性危机是一种严重的,危及生命的疾病.
- 耐火病例往往需要进行甲状腺切除术.
- 手术的最佳时间,特别是关于手术前的甲状腺激素水平,仍在争论中.
研究的目的:
- 评估早期甲状腺切除术在患有甲状腺毒性危机的患者的结果,无论手术前甲状腺激素水平如何.
- 评估这种方法在医疗耐药病例中的安全性和可行性.
主要方法:
- 在2011年至2020年期间诊断出甲状腺风暴的患者 (≥18岁) 的回顾性评估.
- 包括标准包括日本甲状腺协会和伯奇-沃托夫斯基分数>25.
- 数据分析的重点是手术时间,手术前甲状腺状况和术后结果.
主要成果:
- 十二名女性患者接受了早期的全甲状腺切除术.
- 贝塔抑制剂在手术前有效控制了心率 (中位数从每分钟110下降到每分钟76.5下降).
- 并发症包括过渡性低血症和低甲状腺症 (每种为41.67%);没有死亡或血栓栓塞发生.
结论:
- 早期甲状腺切除术是医疗耐药性甲状腺毒性危机的可行和安全选择.
- 严格控制心率至关重要,可能会优先于实现手术前的甲状腺功能减退.
- 这种方法支持及时手术干预的安全性和可行性.
相关概念视频
Synthesis and Regulation of Thyroid Hormones
Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
Hyperthyroidism I: Introduction
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
Hyperthyroidism II: Pathophysiology
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...
Graves' Disease I: Introduction
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence in...
Graves Disease II: Pathophysiology
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
Hypothyroidism II: Pathophysiology
Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...


