A case of thyroid storm with a markedly elevated level of circulating soluble interleukin-2 receptor complicated by multiple organ failure and disseminated intravascular coagulation syndrome
A case of thyroid storm with a markedly elevated level of circulating soluble interleukin-2 receptor complicated by multiple organ failure and disseminated intravascular coagulation syndrome
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DOI：
10.1507/endocrj.ej14-0073
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发表时间：
2014-07-01
影响因子：
2
通讯作者：
Yamada, Masanobu
中科院分区：
文献类型：
--
作者：
Shimoda, Yoko;Satoh, Tetsurou;Yamada, Masanobu
甲状腺风暴(TS)是一种危及生命的内分泌急症。然而，TS的发病机制尚不清楚。一名40岁的男子因体重减轻和黄疸被送往附近的医院。腹部CT扫描5天后，他出现高烧和意识障碍。他被诊断为源于未经治疗的Graves病的TS，并被转移到我们医院的重症监护病房(ICU)。患者出现意识障碍(格拉斯哥昏迷分级为E4V1M4)、高热(39.3℃)、心力衰竭、急性肝功能衰竭和弥散性血管内凝血综合征(DIC)。他循环中的可溶性白介素2受体(sIL-2R)水平显著升高(7416U/mL，参考范围：135-483)。多器官功能衰竭(MOP)和DIC的综合治疗成功地使用了无组织碘、糖皮质激素、抗甲状腺药物、β-受体阻滞剂、利尿剂、抗凝剂以及输注浓缩血小板和新鲜冰冻血浆。SIL-2R水平在最初的治疗过程中逐渐下降，但即使在甲状腺切除术后仍高于参考范围。在非风暴Graves病患者中，血清sIL-2R水平的轻度升高曾与甲状腺激素水平相关。本研究首次证明，TS患者的循环sIL-2R水平可显著升高。SIL-2R水平的显著升高被推测为在TS的发病机制中起未知作用的不适当的全身性免疫反应。
Thyroid storm (TS) is a life-threatening endocrine emergency. However, the pathogenesis of TS is poorly understood. A 40-year-old man was admitted to a nearby hospital with body weight loss and jaundice. Five days after a contrasted abdominal computerized tomography (CT) scan, he exhibited high fever and disturbance of consciousness. He was diagnosed with TS originating from untreated Graves' disease and was transferred to the intensive care unit (ICU) of our hospital. The patient exhibited impaired consciousness (E4V1M4 in Glasgow coma scale), high fever (39.3 degrees C), and atrial flutter with a pulse rate 162/min, and was complicated by heart failure, acute hepatic failure, and disseminated intravascular coagulation syndrome (DIC). His circulating level of soluble interleukin-2 receptor (sIL-2R), a serum marker of an activated immune response, was highly elevated (7,416 U/mL, reference range: 135-483). Multiple organ failure (MOP) and DIC were successfully managed by multimodality treatments using inorganized iodide, glucocorticoids, antithyroid drugs, beta-blockers, and diuretics as well as an anticoagulant agent and the transfusion of platelet concentrate and fresh frozen plasma. sIL-2R levels gradually decreased during the initial treatment, but were still above the reference range even after thyroidectomy. Mild elevations in serum levels of sIL-2R have previously been correlated with thyroid hormone levels in non-storm Graves' disease. The present study demonstrated, for the first time, that circulating sIL-2R levels could be markedly elevated in TS. The marked increase in sIL-2R levels was speculated to represent an inappropriate generalized immune response that plays an unknown role in the pathogenesis of TS.