Abstract
La tiroiditis es un fenómeno inflamatorio de la tiroides, de causas diversas, incluyendo raramente traumas de la región anterior del cuello. Se presenta el caso de un paciente con depresión mayor de curso crónico, con síntomas sicóticos y farmacodependencia, quien intenta suicidarse mediante ahorcamiento. Ingresa con un Glasgow de 3/15, por lo cual requiere intubación orotraqueal inmediata, posterior traslado a unidad de cuidados intensivos y ventilación mecánica durante diez días. Durante este periodo desarrolla taquicardia persistente, diaforesis y alteraciones del sensorio, se encontró TSH en 0,00 (0,4- 4 mUI/ml); una T3 total en 2,42, (0,8-2,0 ng/ml) y T4 libre >6 (0,93-1,70 ng/dL), la gammagrafía de tiroides con tecnecio 99 mostró bloqueo de la captación. Se sospechó tormenta tiroidea y recibió propranolol 80 mg vía oral cada 8 horas en forma continua e hidrocortisona 50 mg intravenosa cada 8 horas durante
5 días. Los controles, dos semanas después, muestran TSH en 0,00 (0,4-4 uUI/ml) y una T4 libre de 1,78 (0,93-1,70 ng/dl) y cuatro días después normalización de la T4 libre (1,45 ng/dl), acompañado de mejoría clínica de los síntomas adrenérgicos.
Se presenta el caso de un paciente con tiroiditis postrauma, entidad que debe ser sospechada en pacientes con trauma en el cuello que presenten síntomas de tirotoxicosis.
Abstract
Thyroiditis is an inflammatory disorder of the thyroid, which stems from a variety of causes including in some rare cases trauma to the neck. We present the case of a male patient with chronic depression associated with psychotic symptoms and drug abuse that tried to commit suicide through hanging. The patient had a Glasgow Coma Scale 3/15 requiring orotracheal intubation, a stay in the intensive care unit and mechanical ventilation for 10 days. While in the ICU the patient developed persistent tachycardia, diaphoresis and changes in mental status. A suppressed TSH was found with a level of 0,00 (0,4-4 uUI/ml) and high thyroid hormone level (total T 2,42, (normal value 0,8-2,0 ng/ml) and free T >6 (normal value 0,93-1,70 ng/dL). A technetium-99 thyroid scintygraphy showed blocked uptake. With those findings, a thyroid storm was suspected and management was begun with propranolol 80 mg per mouth every 8 hours and IV hydrocortisone 50 mg every 8 hours for 5 days. Two weeks later, the TSH was 0,00 (0,4-4 uUI/ ml) and the free T4 was 1,78 (normal value 0,93-1,70 ng/dl). Four days later, the free T4 concentration was normal (1,45 ng/dl) with a clinical improvement of the adrenergic symptoms. Inconclusion, thyroiditis should be suspected in patients with neck trauma with compatible clinical manifestations.
References
2. Blum M, Schloss MF. Martial-arts thyroiditis. N Engl J Med. 1984;311(3):199- 200.
3. Stang MT, Yim JH, Challinor SM, Bahl S, Carty SE. Hyperthyroidism after parathyroid exploration. Surgery. 2005;138(6):1058-64; discussion 64-5.
4. Lederer SR, Schiffl H. Transient hyperthyroidism after total parathyroidectomy for tertiary hyperparathyroidism: a report of two cases.Wien Klin Wochenschr. 2008;120(13-14):432-4. doi: 10.1007/s00508-008-0996-3.
5. Salazar Thieroldt E, Boado Lama J, Molinero Abad S, Miján de la Torre A. Transient hyperthyroidism after total laryngectomy for laryngeal cancer. Nutr Hosp. 2014 Oct 24;31(n01):380-383.
6. Yoon SJ, Kim DM, Kim JU, Kim KW, Ahn CW, Cha BS, et al. A case of thyroid storm due to thyrotoxicosis factitia. Yonsei Med J. 2003;44(2):351-4.
7. Leckie RG, Buckner AB, Bornemann M. Seat belt-related thyroiditis documented with thyroid Tc-99m pertechnetate scans. Clin Nucl Med. 1992;17(11):859-60.
8. Nishihara E, Miyauchi A, Matsuzuka F, Sasaki I, Ohye H, Kubota S, et al. Acute suppurative thyroiditis after fine-needle aspiration causing thyrotoxicosis. Thyroid. 2005;15(10):1183-7.
9. Kobayashi A, Kuma K, Matsuzuka F, Hirai K, Fukata S, Sugawara M. Thyrotoxicosis after needle aspiration of thyroid cyst. J Clin Endocrinol Metab. 1992;75(1):21-4.
10. Carney JA, Moore SB, Northcutt RC, Woolner LB, Stillwell GK. Palpation thyroiditis (multifocal granulomatour folliculitis). Am J Clin Pathol. 1975;64(5):639-47.
11. Ramirez JI, Petrone P, Kuncir EJ, Asensio JA. Thyroid storm induced by strangulation. South Med J. 2004;97(6):608-10.
12. Wartofsky L. Clinical criteria for the diagnosis of thyroid storm. Thyroid. 2012;22(7):659-60.
13. Bergenfelz A, Ahren B. Hyperthyroxinemia after surgery for primary hyperparathyroidism. Langenbecks Arch Chir. 1994;379(3):178-81.
14. Lindblom P, Valdemarsson S, Westerdahl J, Tennvall J, Bergenfelz A. Hyperthyroidism after surgery for primary hyperparathyroidism. Langenbecks Arch Surg. 1999;384(6):568-75.
15. Musi N, Braverman LE, Norris CM, Jr. Severe thyrotoxicosis after parathyroid surgery for hyperparathyroidism. Am J Med. 2000;108(6):519-20.
16. Calle RA, Cohen KL. Transient thyroiditis due to surgical trauma. Am J Med. 1993;95(5):546-8.
17. Yoshida D. Thyroid storm precipitated by trauma. J Emerg Med. 1996;14(6):697-701.
18. Hwang TS, Park SH. Histopathologic study of the so called ‘palpation thyroiditis’. J Korean Med Sci. 1988;3(1):27-9.
19. Jacobs RR. Acute hyperthyroidism precipitated by trauma. South Med J. 1979;72(7):890-1.
20. Doussin JF, Dubost J, Banssillon V. [Post-traumatic hyperthyroxinemia or hyperthyroidism]. Ann Fr Anesth Reanim. 1985;4(1):72-4.
21. Blenke EJ, Vernham GA, Ellis G. Surgery-induced thyroiditis following laryngectomy. J Laryngol Otol. 2004;118(4):313-4.
22. McDermott A, Onyeaka CV, Macnamara M. Surgery-induced thyroiditis: fact or fiction? Ear Nose Throat J. 2002;81(6):408-10.
23. Delikoukos S, Mantzos F. Thyroid storm induced by trauma due to spear fishing-gun trident impaction in the neck. Emerg Med J. 2007;24(5):355-6.
24. Kanbay M, Sengul A, Güvener N. Trauma induced thyroid storm complicated by multiple organ failure. Chin Med J (Engl). 2005;118(11):963-5.
25. Hagiwara A, Murata A, Matsuda T, Sakaki S, Shimazaki S. Thyroid storm after blunt thyroid injury: a case report. J Trauma. 2007;63(3):E85-7.
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent. A copy may be reviewed here