Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
A 75-year-old female patient was admitted to the Intensive Care Unit with the signs of thyrotoxic crisis. Although hyperthyroidism had been previously suspected, thyrosuppressive therapy was not initiated on time. This along with other adverse factors like acute urinary infection contributed to deterioration and unfavorable development of the disease. Clinical improvement was noticed 24 hours from the introduction of combined therapy with propylthiouracil, propranolol, hydrocortisone and cardiotonics for rapid atrial fibrillation caused by atherosclerotic and thyrotoxic heart, supplemented with sedatives and necessary medical care. Shortly upon normalization of the thyroid hormone levels, RJ therapy was administered as a final solution. Pancytopenia verified before the initiation of thyrostatic therapy also contributed to this solution. The intention of this case report is to point to the yet possible occurrence of thyrotoxic crisis, which is nowadays extremely rare owing to appropriate management of hyperthyroidism. Nevertheless, may the disease failed to be recognized on time and therapy is introduced too late, along with other unfavorable factors such as acute infection, the disease can still occur sporadically. Although the mortality rate has been drastically lowered, it is still rather high, i.e. about 7%, therefore these patients should be treated at intensive care unit.Žena u dobi od 75 godina primljena je u Jedinicu za intenzivno liječenje pod slikom tireotoksične krize. Iako se je već ranije sumnjalo na hipertireozu, tireosupresivna terapija nije započeta na vrijeme, što je uz negativne pridružene čimbenike (akutna mokraćna infekcija) doprinijelo nepovoljnom razvoju bolesti. Kombinirana terapija propiltiouracilom, propranololom, hidrokortizonom te kardiotonicima zbog brze atrijske fibrilacije u sklopu aterosklerotskog i tireotoksičnog srca, uza sedative i ostale potporne mjere dovela je do kliničkog poboljšanja već nakon 24 h. Ubrzo nakon normalizacije hormona štitnjače primijenjena je RJ terapija kao definitivno rješenje, čemu je doprinijela i pancitopenija dokazana jo. prije započete terapije tireostaticima. Ovim prikazom želi se ukazati na jo. uvijek moguću pojavu tireotoksične krize koja je danas zahvaljujući primjerenom liječenju hipertireoze izrazito rijetka, no uz neprepoznavanje bolesti i zakašnjelu terapiju te nepovoljne druge čimbenike (npr. akutni infekt) jo. se uvijek može sporadično susresti. Iako je smrtnost drastično smanjena, ipak je jo. uvijek dosta visoka i iznosi oko 7%, zbog čega i takvi bolesnici zahtijevaju smještaj u jedinice za intenzivno liječenje
