全甲狀腺切除術後甲狀腺風暴

Thyroid Storm after Total Thyroidectomy

甲狀腺風暴為甲狀腺機能亢進最嚴重且致命的急性併發症，常因手術、感染或劇烈生理壓力誘發。本文報告一名50歲女性，因甲狀腺機能亢進接受全甲狀腺切除術。病人術前接受propylthiouracil治療，但甲狀腺功能仍未完全控制。手術過程中出現心律不整與血壓波動，術後數小時內發生高熱、心搏過速、意識改變及代謝性酸中毒。實驗室檢查顯示游離甲狀腺素（free T4）與三碘甲狀腺素（T3）顯著升高，Burch–Wartofsky評分（Burch–Wartofsky Point Scale，BWPS）85分，高度懷疑甲狀腺風暴。醫療團隊立即啟動多重治療策略，包括降溫、β交感神經阻斷劑、腎上腺皮質類固醇及經驗性廣效抗生素，並於加護病房進行嚴密監測。病情於術後第2天明顯改善，術後第11天順利出院。本案例顯示，術前未達生化穩定為甲狀腺風暴的重要可修正風險因子。完善的術前評估與代謝控制、手術中溫和操作及術後早期識別與多專科合作，對預防及改善臨床預後至關重要。跨專業整合照護與病人教育亦是提升安全性與降低併發症的核心關鍵。

Thyroid storm represents the most severe and life-threatening manifestation of hyperthyroidism, typically precipitated by surgery, infection, or intense physiological stress. This case report describes a 50-year-old woman with hyperthyroidism who underwent total thyroidectomy. Despite treatment with propylthiouracil, her thyroid function remained inadequately controlled preoperatively. Intraoperatively, she developed arrhythmia and blood pressure instability, followed by high fever, tachycardia, altered consciousness, and metabolic acidosis within several hours after surgery. Laboratory evaluation revealed markedly elevated free T4 and T3 levels, and a Burch–Wartofsky score of 85 was highly suggestive of thyroid storm. Immediate multidisciplinary management—including cooling measures,β-adrenergic blockade, corticosteroid therapy, and empirical broad-spectrum antibiotics—was initiated, with intensive monitoring in the ICU. The patient’s condition improved significantly by postoperative day two, and she was discharged on day eleven. This case underscores that incomplete biochemical stabilization remains a critical modifiable risk factor for postoperative thyroid storm. Thorough preoperative optimization, meticulous intraoperative handling, and vigilant postoperative surveillance, supported by timely multidisciplinary collaboration, are essential to prevent this fatal complication and improve outcomes. Moreover, interprofessional coordination and patient education are key strategies to enhance safety and reduce perioperative risks among hyperthyroid patients undergoing surgery.