Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Sep;38(9):860-865. doi: 10.3760/cma.j.cn121430-20260207-00078.
ABSTRACT
Thyroid crisis is caused by an excess of thyroid hormones in the body, leading to a hypermetabolic state and a series of pathological and physiological changes. Clinical manifestations are often non-specific, and in severe cases, it can manifest as multiple organ dysfunction. Acute myocardial infarction combined with thyroid crisis is dangerous and has a high mortality rate. Timely identification and combination of mechanical circulatory support and antithyroid drug treatment are key to improving prognosis. On January 28, 2021, a 49-year-old female patient was admitted to Yanbian University Affiliated Hospital due to "altered mental status for 4 hours, cardiopulmonary during this period". After cardiopulmonary resuscitation, her vital signs were extremely unstable, and electrocardiogram and myocardial enzymes showed acute non-ST-segment elevation myocardial infarction with severe heart function decline (ejection fraction 26%). On the third day of admission, she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, and on the sixth day, she underwent percutaneous coronary stent implantation. After surgery, the patient continued to experience recurrent persistent hyperpyrexia and profuse diaphoresis. Screening revealed a significant increase in thyroid hormones and inhibition of thyroid-stimulating hormone. Combined with thyroid ultrasound and Burch-Wartofsky score>45 points, the diagnosis was confirmed to be hyperthyroidism and thyroid crisis. Subsequently, treatment was given with propylthiouracil, propranolol, and hydrocortisone. On the 9th day of admission, extracorporeal membrane oxygenation (ECMO) was successfully withdrawn, cardiac function recovered (ejection fraction of 60%), consciousness improved, and finally the patient was weaned off the ventilator and transferred to a primary hospital for rehabilitation. After 3 months of follow-up, normal life and work were resumed. This case study suggests that early application of ECMO combined with antithyroid therapy can significantly improve the prognosis of patients with refractory cardiogenic shock and thyroid crisis. Even without a clear history of hyperthyroidism, acute coronary events may trigger crisis, and clinical vigilance should be maintained.
PMID:42875246 | DOI:10.3760/cma.j.cn121430-20260207-00078