A report of 8 cases with thyroid crisis treated in an emergency and critical care center

Abstract

A report of Background : Due to its severity, thyroid crisis (TC) is occasionally treated in emergency care centers without ex-perts on endocrine disease. Objective : To clarify clinical outcomes and prognostic factors for TC treated in our hospital. Cases : Data were retrospectively collected from 8 patients (mean age, 48 years; 2 males) diagnosed with TC after 2000. All patients had Graves’ disease and were not on anti-thyroid drugs at onset. Plasma exchange (PE) was per-formed for 4 patients. Three patients who required PE and circulatory support (CS) for shock died due to non-ob-structive mesenteric infarction (n=1) or liver deficiency (n=2), although all patients were removed from CS and an-other patient died due to sepsis after surgery. In comparisons between the 4 survivors and 4 non-survivors, SOFA score (5.3 vs. 10.0; p=0.04) was significantly higher and total bilirubin value (TB) (0.9 mg/dL vs. 3.7 mg/dL; p=0.19), systolic blood pressure (SBP) (135 mmHg vs. 80.3 mmHg; p=0.25) and plasma glucose level (PG) (131.5 mg/dL vs. 66.3 mg/dL; p=0.159) tended to be higher, lower and lower in NS than S, respectively. Conclusions : TC patients with high TB and low SBP and PG in addition to high SOFA score might warrant particu-lar attention. (JJAAM.