Postpartum thyroid crisis: a case report and literature review

doi:10.3877/cma.j.issn.2096-1537.2021.04.015

Abstract

Abstract:

The treatment of critically ill pregnant women has always been the focus of the World Health Organization. Thyroid crisis is a serious complication of hyperthyroidism. Delayed or improper treatment may have serious fatal consequences. It is expected and through literature review to systematically analyze the effectiveness and limitations of blood purification treatment in the early stage of perinatal thyroid crisis, so as to provide clinical reference for effective treatment of this complication.

Key words: Critical pregnant women, Thyroid crisis, Blood purification

Yajun Liu, Tao Chen, Liting Cheng, Xue Xiong, Xingmei Wang. Postpartum thyroid crisis: a case report and literature review[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 368-371.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.04.015

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I04/368

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References 15

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甲功全套	正常范围	9月28日（手术前）	9月29日（手术后置换前）	10月1日（第1次置换后）	10月3日（第3次置换后）	10月5日（第4次置换后）	10月8日（第5次置换后）	10月16日（出院前）
第三代促甲状腺素（μIU/ml）	0.55~4.70	0.007	0.002	0.011	0.020	0.021	0.002	0.006
游离T3（pmol/L）	2.77~6.31	11.9	15.6	7.8	5.8	6.1	2.0	3.0
游离T4（pmol/L）	10.48~24.38	55.1	57.1	55.2	43.0	37.1	19.7	17.9
三碘甲腺原氨酸（nmol/L）	1.02~2.96	4.90	6.96	1.99	1.44	1.63	0.65	-
甲状腺素（nmol/L）	55.47~161.25	＞387	＞387	316.8	203.4	161.1	117.3	-
甲状腺球蛋白抗体（IU/ml）	0~115	667.6	745.3	582.4	484.3	395.9	795.3	-
甲状腺球蛋白（ng/ml）	3.5~77.0	5.850	5.680	1.350	2.390	1.180	0.261	-
甲状腺过氧化物酶抗体（IU/ml）	0~34	574.0	＞600	354.1	503.2	198.3	97.0	-
促甲状腺素受体抗体（IU/L）	＜1.75	2.36	2.98	1.50	1.38	1.43	0.58	-

甲功全套	正常范围	9月28日（手术前）	9月29日（手术后置换前）	10月1日（第1次置换后）	10月3日（第3次置换后）	10月5日（第4次置换后）	10月8日（第5次置换后）	10月16日（出院前）
第三代促甲状腺素（μIU/ml）	0.55~4.70	0.007	0.002	0.011	0.020	0.021	0.002	0.006
游离T3（pmol/L）	2.77~6.31	11.9	15.6	7.8	5.8	6.1	2.0	3.0
游离T4（pmol/L）	10.48~24.38	55.1	57.1	55.2	43.0	37.1	19.7	17.9
三碘甲腺原氨酸（nmol/L）	1.02~2.96	4.90	6.96	1.99	1.44	1.63	0.65	-
甲状腺素（nmol/L）	55.47~161.25	＞387	＞387	316.8	203.4	161.1	117.3	-
甲状腺球蛋白抗体（IU/ml）	0~115	667.6	745.3	582.4	484.3	395.9	795.3	-
甲状腺球蛋白（ng/ml）	3.5~77.0	5.850	5.680	1.350	2.390	1.180	0.261	-
甲状腺过氧化物酶抗体（IU/ml）	0~34	574.0	＞600	354.1	503.2	198.3	97.0	-
促甲状腺素受体抗体（IU/L）	＜1.75	2.36	2.98	1.50	1.38	1.43	0.58	-

心功能检查	9月29日（手术后置换前）	10月1日（第1次置换后）	10月3日（第3次置换后）	10月4日（第4次置换后）	10月5日（第4次置换后）	10月7日（第5次置换后）
二尖瓣反流量	中大量	中大量	中量	中量	中大量	中量
肺动脉收缩压（mmHg）	40	41	41	40	40	40
左室收缩功能（%）
左室射血分数	40	45	50	56	55	58
左室收缩末容积	20	23	26	30	29	31
左室舒张功能（E/A）	＞1	＞1	＞1	＞1	＞1	＞1

心功能检查	9月29日（手术后置换前）	10月1日（第1次置换后）	10月3日（第3次置换后）	10月4日（第4次置换后）	10月5日（第4次置换后）	10月7日（第5次置换后）
二尖瓣反流量	中大量	中大量	中量	中量	中大量	中量
肺动脉收缩压（mmHg）	40	41	41	40	40	40
左室收缩功能（%）
左室射血分数	40	45	50	56	55	58
左室收缩末容积	20	23	26	30	29	31
左室舒张功能（E/A）	＞1	＞1	＞1	＞1	＞1	＞1

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