title: Successful treatment of thyroid crisis accompanied by hypoglycemia, lactic acidosis, and multiple organ failure.
abstract: We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation--rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically. Prompt treatments such as mechanical ventilation, plasma exchange, and continuous venovenous hemofiltration were preformed, along with antithyroid medication. The patient finally survived after 3 weeks of intensive care. We herein discuss the possible mechanisms of these metabolic disorders in thyroid crisis and possible therapeutic measures that could be used to reduce mortality.
authors.affiliation: Department of Emergency, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Deng
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zheng
authors.forename: Jihong
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000140:Acidosis, Lactic / Q000209:etiology*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D013958:Thyroid Crisis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013960:Thyroid Function Tests