Treatment of thyroid storm during pregnancy

doi:10.3877/cma.j.issn.2095-3259.2017.02.003

Abstract

Abstract:

Thyroid storm during pregnancy is very rare. It easily occurs in the pregnancy with untreated or inadequately treated thyrotoxicosis. Its mortality rate reaches 20%. The exact pathophysiology is not well understood, but may relate with the stress state during labor process and perioperative period of caesarean section. The treatment of thyroid storm should be managed by a team consisting of an endocrinologist and maternal-fetal specialist of intensive care unit.

Key words: Hyperthyroidism, Thyroid crisis, Pregnancy, high-risk

Weijie Sun, Ying Gao. Treatment of thyroid storm during pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(02): 73-78.

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Figures/Tables 1

References 9

[1]	American College of Obstetricians and Gynecologists. Practice Bulletin No. 148：Thyroid disease in pregnancy[J]. Obstet Gynecol, 2015, 125(4):996-1005.
[2]	中华医学会内分泌学分会，中华医学会围产医学分会．妊娠和产后甲状腺疾病的诊治指南[J]．中华围产医学杂志，2012, 15(7):385-403.
[3]	Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys[J]. Thyroid, 2012, 22(7):661-679.
[4]	Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm[J]. Endocrinol Metab Clin North Am, 1993, 22(2):263-277.
[5]	Khoo CM, Lee KO. Endocrine emergencies in pregnancy[J]. Best Pract Res Clin Endocrinol Metab, 2013, 27(6):885-891.
[6]	中华医学会内分泌学分会，《中国甲状腺疾病诊治指南》编写组．中国甲状腺疾病诊治指南-甲状腺功能亢进症[J]. 中华内科杂志，2007, 10(46):876-882.
[7]	De Leo S, Lee SY, Braverman LE. Hyperthyroidism[J]. Lancet, 2016, 388(10047):906-918.
[8]	Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum[J]. Thyroid, 2017, 27(3):315-389.
[9]	施秉银. 甲状腺危象的药物处理[J]. 药品评价，2013, 10(15):29-31.

临床表现		评分
体温(℃)		?
?	37.2～37.7	5
?	37.8～38.2	10
?	38.3～38.8	15
?	38.9～39.4	20
?	39.4～39.9	25
?	>40.0	30
中枢神经系统影响		?
?	无	0
?	轻度(烦躁不安)	10
?	中度(谵妄、精神错乱、昏睡)	20
?	重度(抽搐、昏迷)	30
消化系统异常		?
?	无	0
?	中度(腹泻、恶心/呕吐、腹痛)	10
?	重度(不明原因的黄疸)	20
心血管功能异常[心动过速(次/min)]		?
?	90～109	5
?	110～119	10
?	120～129	15
?	130～139	20
?	≥140	25
充血性心力衰竭		?
?	无	0
?	轻度(足部水肿)	5
?	中度(双侧湿啰音)	10
?	重度(肺水肿)	15
房颤		?
?	无	0
?	有	10
诱发因素		?
?	无	0
?	有(手术、感染等)	10

临床表现		评分
体温(℃)		?
?	37.2～37.7	5
?	37.8～38.2	10
?	38.3～38.8	15
?	38.9～39.4	20
?	39.4～39.9	25
?	>40.0	30
中枢神经系统影响		?
?	无	0
?	轻度(烦躁不安)	10
?	中度(谵妄、精神错乱、昏睡)	20
?	重度(抽搐、昏迷)	30
消化系统异常		?
?	无	0
?	中度(腹泻、恶心/呕吐、腹痛)	10
?	重度(不明原因的黄疸)	20
心血管功能异常[心动过速(次/min)]		?
?	90～109	5
?	110～119	10
?	120～129	15
?	130～139	20
?	≥140	25
充血性心力衰竭		?
?	无	0
?	轻度(足部水肿)	5
?	中度(双侧湿啰音)	10
?	重度(肺水肿)	15
房颤		?
?	无	0
?	有	10
诱发因素		?
?	无	0
?	有(手术、感染等)	10

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[2]	Cun-mei SU. Preconception Care for Child-Bearing Aged Women With Thyroid Disease [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2011, 07(05): 484-487.
[3]	Shu-qing ZHANG, Shu-yu HUANG, Wei-yu CHEN. Clinical Analysis of 52 Pregnancy Cases With Hyperthyroidism [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2011, 07(04): 335-337.
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[15]	Canzhui Li, Zhaohui Li, Qiang Zhou, Zhiwei Luo. Correlation between hyperthyroidism and risk of stroke: a meta-analysis based on prospective cohort studies [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2016, 02(04): 230-236.

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