以新发扩张型心肌病和心源性休克为表现的麻痹性甲状腺风暴
Apathetic Thyroid Storm Presenting as New-Onset Dilated Cardiomyopathy and Cardiogenic Shock.
摘要(中文译文)
甲状腺危象是一种少见但危及生命的内分泌急症，死亡率高，且由于缺乏普遍可靠的鉴别标准以区分其与严重甲状腺毒症，诊断在很大程度上仍依赖临床表现；不典型或“淡漠型”表现尤为罕见，可延误识别。一名既往无病史的49岁男性，表现为两周进行性全身水肿、心悸及非特异性胃肠道症状，无发热或躁动，检查发现心房颤动伴快速心室率及失代偿性心力衰竭。实验室检查显示促甲状腺激素受抑制，游离T3和T4显著升高，超声心动图显示弥漫性运动减弱，射血分数为25-30%。其Burch-Wartofsky评分为60分，支持甲状腺危象的诊断。尽管进展为心源性休克，患者经心率控制、积极利尿、艾司洛尔、甲巯咪唑及糖皮质激素治疗后好转，无需正性肌力药物支持；随后的门诊评估证实为Graves病，一年后患者仍维持甲状腺功能正常，心室功能逐渐恢复。本病例提示，淡漠型甲状腺危象可主要表现为严重心肌病和休克，而缺乏典型的高肾上腺素能体征，强调了早期识别和及时靶向治疗对获得良好结局的重要性。
Abstract
Thyroid storm is an uncommon but life-threatening endocrine emergency associated with high mortality, and its diagnosis remains largely clinical due to the lack of universally reliable criteria to distinguish it from severe thyrotoxicosis; atypical or "apathetic" forms are particularly rare and can delay recognition. A 49-year-old man with no prior medical history presented with a two-week history of progressive anasarca, palpitations, and nonspecific gastrointestinal symptoms in the absence of fever or agitation and was found to have atrial fibrillation with rapid ventricular response and decompensated heart failure. Laboratory studies showed a suppressed thyroid-stimulating hormone with markedly elevated free T3 and T4, while echocardiography revealed global hypokinesis with an ejection fraction of 25-30%. His Burch-Wartofsky score of 60 supported the diagnosis of thyroid storm. Despite progression to cardiogenic shock, he improved with rate control, aggressive diuresis, esmolol, methimazole, and glucocorticoids without requiring inotropic support; subsequent outpatient evaluation confirmed Graves' disease, and at one year, he remains euthyroid with recovering ventricular function. This case highlights that apathetic thyroid storm may present predominantly with severe cardiomyopathy and shock in the absence of classic hyperadrenergic signs, underscoring the importance of early recognition and prompt targeted therapy for favorable outcomes.
如何引用
AMA
Pragya Bhandari, Tark Abou-Elmagd, Shreebridhi Pande, Nirajan Kandel, Inmaculada Ncogo Alene. Apathetic Thyroid Storm Presenting as New-Onset Dilated Cardiomyopathy and Cardiogenic Shock.. Cureus. 2026; doi:10.7759/cureus.108388.
APA
Pragya Bhandari, Tark Abou-Elmagd, Shreebridhi Pande, Nirajan Kandel, Inmaculada Ncogo Alene (2026). Apathetic Thyroid Storm Presenting as New-Onset Dilated Cardiomyopathy and Cardiogenic Shock.. Cureus. https://doi.org/10.7759/cureus.108388
GB/T 7714
Pragya Bhandari, Tark Abou-Elmagd, Shreebridhi Pande, Nirajan Kandel, Inmaculada Ncogo Alene. Apathetic Thyroid Storm Presenting as New-Onset Dilated Cardiomyopathy and Cardiogenic Shock.[J]. Cureus, 2026 doi:10.7759/cureus.108388.
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