PDF(Pubmed)
Abstract：
UNASSIGNED: Thyroid storm is a potentially fatal thyrotoxicosis triggered by an event, such as manipulation of the thyroid gland, acute iodine load, trauma, or infection. Prior to deciding on fine needle aspiration (FNA) biopsy, patients who have been diagnosed with hyperthyroidism or low thyroid stimulating hormone and multinodular goiter (MNG) should be imaged via radionuclide thyroid scan.
UNASSIGNED: We present a case of a 62-year-old female patient with history of MNG, who had thyrotoxicosis on presentation due to medication noncompliance and was found to have Graves\' disease. Computed tomography scan without intravenous iodine contrast injection showed a heterogeneously appearing and notably enlarged thyroid gland with a 6.2 cm × 5.8 cm right thyroid lobe and 5.5 cm × 5.0 cm left lobe. There was a resultant narrowing of the trachea measuring 6 mm in the transverse dimension at its narrowest point. Further evaluation with dedicated ultrasound of the thyroid showing bilateral MNG with coarse calcifications as well as a notable left thyroid cyst measuring 1.6 cm × 1.2 cm × 2.3 cm, isoechoic, with smooth margins. The patient was started on methimazole 40 mg/day, cholestyramine 4 mg four times per day, prednisone 20 mg/day, saturated solution of potassium iodide 50 mg three times daily, and propranolol for heart rate control. Another service recommended FNA biopsy of the right 3 cm thyroid nodule. Two days after undergoing an FNA, she experienced a thyroid storm, requiring emergent total thyroidectomy as a life-saving procedure.
UNASSIGNED: FNA is rarely needed in the case of a hyperfunctioning thyroid nodule, as it can be seen on radionuclide thyroid scan. However, when executed, a euthyroid state needs to be achieved before attempting to perform an FNA. Total thyroidectomy is warranted in a hyperthyroid state in an emergent setting without ample time for medical therapy to be effective, as seen in our reported case.
UNASSIGNED: We present a case of a 62-year-old female patient with history of MNG, who had thyrotoxicosis on presentation due to medication noncompliance and was found to have Graves\' disease. Computed tomography scan without intravenous iodine contrast injection showed a heterogeneously appearing and notably enlarged thyroid gland with a 6.2 cm × 5.8 cm right thyroid lobe and 5.5 cm × 5.0 cm left lobe. There was a resultant narrowing of the trachea measuring 6 mm in the transverse dimension at its narrowest point. Further evaluation with dedicated ultrasound of the thyroid showing bilateral MNG with coarse calcifications as well as a notable left thyroid cyst measuring 1.6 cm × 1.2 cm × 2.3 cm, isoechoic, with smooth margins. The patient was started on methimazole 40 mg/day, cholestyramine 4 mg four times per day, prednisone 20 mg/day, saturated solution of potassium iodide 50 mg three times daily, and propranolol for heart rate control. Another service recommended FNA biopsy of the right 3 cm thyroid nodule. Two days after undergoing an FNA, she experienced a thyroid storm, requiring emergent total thyroidectomy as a life-saving procedure.
UNASSIGNED: FNA is rarely needed in the case of a hyperfunctioning thyroid nodule, as it can be seen on radionuclide thyroid scan. However, when executed, a euthyroid state needs to be achieved before attempting to perform an FNA. Total thyroidectomy is warranted in a hyperthyroid state in an emergent setting without ample time for medical therapy to be effective, as seen in our reported case.
摘要：
■甲状腺风暴是由事件引发的潜在致命的甲状腺毒症，比如操纵甲状腺，急性碘负荷，创伤,或感染。在决定细针穿刺(FNA)活检之前,被诊断为甲状腺功能亢进或促甲状腺激素水平低下和多结节性甲状腺肿(MNG)的患者应通过放射性核素甲状腺扫描进行成像.
■我们介绍一例62岁女性患者，有MNG病史，患者因用药不合规而出现甲状腺毒症，并被发现患有Graves病。未注射静脉碘对比剂的计算机断层扫描显示甲状腺外观不均匀且明显肿大，右叶为6.2cm×5.8cm，左叶为5.5cm×5.0cm。结果气管在其最窄点的横向尺寸上变窄了6mm。甲状腺专用超声进一步评估：双侧MNG伴粗糙钙化，左侧甲状腺囊肿见1.6cm×1.2cm×2.3cm，等回声,平滑的边缘。患者开始服用甲氧咪唑40毫克/天，胆甾胺4毫克，每天4次，泼尼松20毫克/天，碘化钾饱和溶液50毫克，每日三次，和心律控制.另一项服务建议FNA活检右侧3厘米甲状腺结节。在接受FNA两天后，她经历了甲状腺风暴,需要紧急全甲状腺切除术作为挽救生命的程序。
■在甲状腺结节功能亢进的情况下，很少需要FNA，正如在放射性核素甲状腺扫描上可以看到的。然而,当被执行时，在尝试进行FNA之前,需要达到甲状腺功能正常的状态.甲状腺全切术是必要的甲状腺功能亢进状态在紧急设置没有充足的时间药物治疗是有效的，从我们报道的病例中可以看出。
■我们介绍一例62岁女性患者，有MNG病史，患者因用药不合规而出现甲状腺毒症，并被发现患有Graves病。未注射静脉碘对比剂的计算机断层扫描显示甲状腺外观不均匀且明显肿大，右叶为6.2cm×5.8cm，左叶为5.5cm×5.0cm。结果气管在其最窄点的横向尺寸上变窄了6mm。甲状腺专用超声进一步评估：双侧MNG伴粗糙钙化，左侧甲状腺囊肿见1.6cm×1.2cm×2.3cm，等回声,平滑的边缘。患者开始服用甲氧咪唑40毫克/天，胆甾胺4毫克，每天4次，泼尼松20毫克/天，碘化钾饱和溶液50毫克，每日三次，和心律控制.另一项服务建议FNA活检右侧3厘米甲状腺结节。在接受FNA两天后，她经历了甲状腺风暴,需要紧急全甲状腺切除术作为挽救生命的程序。
■在甲状腺结节功能亢进的情况下，很少需要FNA，正如在放射性核素甲状腺扫描上可以看到的。然而,当被执行时，在尝试进行FNA之前,需要达到甲状腺功能正常的状态.甲状腺全切术是必要的甲状腺功能亢进状态在紧急设置没有充足的时间药物治疗是有效的，从我们报道的病例中可以看出。
