严重甲状腺毒症是一种急性和危及生命的甲状腺功能亢进状态。虽然这是甲状腺功能亢进的罕见表现,它具有临床意义,因为它的高死亡率和需要早期识别和治疗,以减少不良结局的发生率.这种高代谢状态的最常见原因是Graves病,毒性甲状腺腺瘤或多结节性甲状腺肿,甲状腺炎,碘诱发的甲状腺功能亢进,和过量摄入左甲状腺素.不太常见的原因包括创伤,药物(即,胺碘酮),停用抗甲状腺药物,以及与拟交感神经药物如氯胺酮的相互作用,可能在全身麻醉期间给药。不管病因如何,甲状腺毒症的管理应采用跨学科的团队方法进行协调,以优化结局.我们讨论了需要紧急手术的磨牙妊娠是甲状腺毒症的罕见原因,并强调了适当的处理步骤。患者的症状在术后缓解,术后实验室检查结果(甲状腺功能和β-人绒毛膜促性腺激素{β-hCG}),直至恢复正常.患者的术前介绍和准备与多学科小组讨论,术中麻醉注意事项和过程,描述了术后管理和随访。
Severe thyrotoxicosis is an acute and life-threatening state of hyperthyroidism. While it is a rare presentation of hyperthyroidism, it is clinically significant because of its high mortality and necessitates early identification and treatment to reduce the incidence of poor outcomes. The most common causes of this hypermetabolic state are Graves\' disease, toxic thyroid adenoma or multinodular goiter, thyroiditis, iodine-induced hyperthyroidism, and excessive intake of levothyroxine. The less common causes include trauma, medications (i.e., amiodarone), discontinuation of anti-thyroid medications, and interactions with sympathomimetic medications such as ketamine that may be administered during general anesthesia. Regardless of etiology, thyrotoxicosis management should be coordinated using an interdisciplinary team-based approach to optimize outcomes. We discuss a molar pregnancy requiring emergency surgery as an uncommon cause of thyrotoxicosis and highlight appropriate management steps. The patient\'s symptoms resolved post-operatively, and her post-operative laboratory results (thyroid function and beta-human chorionic gonadotropin {β-hCG}) were followed until they normalized. The patient\'s preoperative presentation and preparation with a multidisciplinary team discussion, intraoperative anesthetic considerations and course, and post-operative management and follow-up are described.