PDF(Pubmed)
Abstract：
BACKGROUND: Thyroid storm can be complicated by liver dysfunction, which may occasionally progress to acute liver failure. We herein report a case of acute liver failure following thyroid storm that was treated with living donor liver transplantation after resuscitation from cardiopulmonary arrest.
METHODS: The patient was a woman in her 40 s who had been diagnosed with an abnormal thyroid function. She suffered from fatigue and vomiting, and was found to have consciousness disorder, a fever, and tachycardia with a neck mass. She was diagnosed with thyroid storm and was referred to our hospital. After arrival, she went into cardiopulmonary arrest and veno-arterial extracorporeal membrane oxygenation was initiated. In addition to treatment for thyroid storm with antithyroid drugs, steroids, and plasma exchange, extracorporeal life support was required for 5 days. However, despite improvements in her thyroid function, her liver function deteriorated. We planned living donor liver transplantation for acute liver failure after ensuring the recovery and control of the thyroid function following total thyroidectomy. The donor was her husband who donated the right lobe of his liver. Although she experienced acute cellular rejection after surgery, and other complications-including intra-abdominal hemorrhaging and ischemic changes in the intestine-her liver function and general condition gradually improved. One year after living donor liver transplantation, the patient was in a good condition with a normal liver function.
CONCLUSIONS: To our knowledge, this is the first report of living donor liver transplantation in a patient with acute liver failure following thyroid storm. Liver transplantation should be recognized as an effective treatment for acute liver failure following thyroid storm.
METHODS: The patient was a woman in her 40 s who had been diagnosed with an abnormal thyroid function. She suffered from fatigue and vomiting, and was found to have consciousness disorder, a fever, and tachycardia with a neck mass. She was diagnosed with thyroid storm and was referred to our hospital. After arrival, she went into cardiopulmonary arrest and veno-arterial extracorporeal membrane oxygenation was initiated. In addition to treatment for thyroid storm with antithyroid drugs, steroids, and plasma exchange, extracorporeal life support was required for 5 days. However, despite improvements in her thyroid function, her liver function deteriorated. We planned living donor liver transplantation for acute liver failure after ensuring the recovery and control of the thyroid function following total thyroidectomy. The donor was her husband who donated the right lobe of his liver. Although she experienced acute cellular rejection after surgery, and other complications-including intra-abdominal hemorrhaging and ischemic changes in the intestine-her liver function and general condition gradually improved. One year after living donor liver transplantation, the patient was in a good condition with a normal liver function.
CONCLUSIONS: To our knowledge, this is the first report of living donor liver transplantation in a patient with acute liver failure following thyroid storm. Liver transplantation should be recognized as an effective treatment for acute liver failure following thyroid storm.
摘要：
背景：甲状腺风暴可并发肝功能障碍，偶尔会进展为急性肝功能衰竭。我们在此报告一例甲状腺风暴后的急性肝衰竭病例，该病例在心肺骤停复苏后接受活体供体肝移植治疗。
方法：患者是一名40多岁的女性，被诊断为甲状腺功能异常。她患有疲劳和呕吐，被发现有意识障碍，发烧，伴有颈部肿块的心动过速.她被诊断出患有甲状腺风暴，并被转诊到我们医院。抵达后,她进入了心肺骤停，并开始了静脉动脉体外膜氧合。除了抗甲状腺药物治疗甲状腺风暴，类固醇,和血浆置换，需要5天的体外生命支持.然而,尽管她的甲状腺功能有所改善,她的肝功能恶化了.在确保甲状腺全切除术后甲状腺功能恢复和控制后，我们计划活体供肝移植治疗急性肝功能衰竭。捐赠者是她的丈夫，他捐赠了他肝脏的右叶。尽管她在手术后经历了急性细胞排斥反应，和其他并发症-包括腹腔内出血和肠缺血性改变-她的肝功能和一般状况逐渐改善。活体肝移植后一年，患者情况良好，肝功能正常。
结论：据我们所知，这是甲状腺风暴后急性肝功能衰竭患者的活体肝移植的首次报道。肝移植应被认为是甲状腺风暴后急性肝衰竭的有效治疗方法。
方法：患者是一名40多岁的女性，被诊断为甲状腺功能异常。她患有疲劳和呕吐，被发现有意识障碍，发烧，伴有颈部肿块的心动过速.她被诊断出患有甲状腺风暴，并被转诊到我们医院。抵达后,她进入了心肺骤停，并开始了静脉动脉体外膜氧合。除了抗甲状腺药物治疗甲状腺风暴，类固醇,和血浆置换，需要5天的体外生命支持.然而,尽管她的甲状腺功能有所改善,她的肝功能恶化了.在确保甲状腺全切除术后甲状腺功能恢复和控制后，我们计划活体供肝移植治疗急性肝功能衰竭。捐赠者是她的丈夫，他捐赠了他肝脏的右叶。尽管她在手术后经历了急性细胞排斥反应，和其他并发症-包括腹腔内出血和肠缺血性改变-她的肝功能和一般状况逐渐改善。活体肝移植后一年，患者情况良好，肝功能正常。
结论：据我们所知，这是甲状腺风暴后急性肝功能衰竭患者的活体肝移植的首次报道。肝移植应被认为是甲状腺风暴后急性肝衰竭的有效治疗方法。
