【摘 要】
：
Thyroid crisis is a serious and life-threatening syndrome with multiple organ failure induced by thyrotoxicosis, but the mechanism by which acute illness or injury precipitates thyroid crisis is still
【机 构】
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Osaka University Graduate School of Medicine Japan
【出 处】
：
BIT`s 2nd Annual World Congress of Endobolism-2012(2012第二届内分
论文部分内容阅读
Thyroid crisis is a serious and life-threatening syndrome with multiple organ failure induced by thyrotoxicosis, but the mechanism by which acute illness or injury precipitates thyroid crisis is still poorly understood.Although even cases with not severe thyrotoxicosis sometimes induce thyroid crisis, it is difficult to distinguish thyroid crisis from general thyrotoxicosis with thyroid function laboratory tests and the former is diagnosed only by clinical symptoms.A scoring system with worldwide application to aid diagnosis has been proposed by Burch and Wartofsky and proved useful.However, as their scoring system entails several problems since it dose not include the thyroid function tests and sometimes yields positive results for severe cases without thyroid crisis, the rationale for this scoring system is not clear.The Japanese Thyroid Association therefore formulated new guidelines for diagnosis of thyroid crisis in 2008.However, no treatment guidelineshas been established yet.To rescue patients with thyroid crisis requires multidisciplinary treatments by s and cardiologists in the emergency room or intensive care unit.However, in spite of these advances, mortality from thyroid crisis is still 20-75%.Recently, we dealt with several cases of thyroid crisis induced by untreated Graves diseases accompanied by severe heart failure (left ventricular ejection fraction was about 20%).In both these cases, it was difficult to overcome the cardiac and liver failure with general drug treatments using the antithyroid drug and iodine.However, the combined therapy of steroid pulse and plasma pheresis brought about striking improvement in the patients cardiac function and general condition and and all of them survived.Additionally, this experience suggests that plasma pheresis not only eliminates thyroid hormone but also reduces the plasma TRAb (TSH receptor antibody) levels.We anticipate that the combined therapy of steroid pulse and plasma pheresis may help to improve the survival rate for thyroid crisis with severe organ failure which shows resistance against the general drug treatments.
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