Diagnosis dan Manajemen Thyroid Storm dengan Komplikasi Kardiak: Laporan Kasus
DOI:
https://doi.org/10.31004/prepotif.v8i3.37093Keywords:
atrial fibrilasi, badai tiroid, Burch Wartofsky Point Scale, hipertiroid, tirotoksikosis.Abstract
Thyroid Storm (TS) merupakan keadaan hipermetabolik akut darurat langka, ditandai dengan kegagalan multipel organ, yang dapat terjadi dengan atau tanpa diagnosis tirotoksikosis sebelumnya. Diagnosis dan penanganan tepat sangatlah penting untuk mencegah morbiditas dan mortalitas. Seorang wanita, 26 tahun, dengan keluhan dada berdebar disertai sesak, demam hilang timbul, berkeringat sepanjang hari, gelisah, mual, dan muntah sejak 2 minggu SMRS yang semakin buruk 3 hari SMRS. Pasien memiliki riwayat hipertensi, namun riwayat hipertiroid tidak diketahui. Pada pemeriksaan fisik, tekanan darah 110/70 mmHg, nadi 146x/menit, pernafasan 30x/menit, suhu 38,9°C, exophthalmos, goiter, ronki basah halus paru bilateral dan tremor. Hasil EKG didapatkan AF RVR dan hasil rontgen toraks menunjukkan kardiomegali. Hasil ekokardiografi menunjukkan LVH dengan EF 47% dan mild moderate regurgitasi mitral. Hasil FT4: 7,77 ng/dL dan TSH: 0,05 mIU/mL. Burch Wartofksy Point Scale pasien sebesar 85. Terapi awal IGD diberikan O2 NC 3 LPM, Paracetamol 1gr IV, Omeprazole 40mg IV, Ondansetron 4mg IV, Digoxin 0,50mg IV, Warfarin tablet 1x2mg, dan Candesartan tablet 1x8mg. Setelah keluar hasil TSH dan FT4, diberikan tambahan PTU loading 600mg, dilanjutkan dengan 4x200mg, Propanolol loading 40mg, dilanjutkan dengan 4x20mg, Dexamethasone 2x5mg IV, dan Furosemide 1x20mg IV. Pasien mengalami TS yang disebabkan oleh untreated hyperthyroidism. Dengan tingginya morbiditas dan mortalitas TS, resusitasi darurat sangat diperlukan, sambil menentukan dan mengobati pemicu yang mendasari. Penatalaksanaan TS meliputi stabilisasi kardiovaskular, pemberian steroid, tionamida, penghambat beta, pengobatan hipertermia dan agitasi. Identifikasi TS yang cepat, manajemen tepat dan adekuat dapat meningkatkan kesintasan pasien dengan komplikasi kardiak.References
Akamizu, T. (2018). Thyroid Storm: A Japanese Perspective. Thyroid, 28(1), 32–40. https://doi.org/10.1089/thy.2017.0243
Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg,
Bartalena, L., Kahaly, G. J., & Krassas, G. E. (2016). Thyroid storm. European Thyroid Journal, 5(4), 234-241.
Burch, H. B., & Wartofsky, L. (2017). Thyroid storm: Clinical features, diagnosis, and treatment. Thyroid, 27(5), 634-640.
Canaris, G. J., Manowitz, N. R., Mayor, G., & Ridgway, E. C. (2020). The prevalence of thyroid disease in the United States: The national health and nutrition examination survey 1988 to 1994. Archives of Internal Medicine, 160(4), 523-528.
Chiha, M., Samarasinghe, S., & Kabaker, A. S. (2013). Thyroid Storm. Journal of Intensive Care Medicine, 30(3), 131–140. https://doi.org/10.1177/0885066613498053
DeGroot, L. J., Kaplan, M. M., & McFadden, D. W. (2020). Endocrinology: Adult and pediatric. 7th ed. Elsevier.
Jain, A., & Woeber, K. A. (2015). Thyroid storm: Diagnosis and management. Thyroid, 25(1), 60-65.
Layal Chaker, Cooper, D. S., Walsh, J. P., & Peeters, R. P. (2024). Hyperthyroidism. The Lancet, 403(10428). https://doi.org/10.1016/s0140-6736(23)02016-0
Muhammad Rakhman, & Rulli Rosandi. (2023). Pitfall of Thyroid Storm Score. Clinical and Research Journal in Internal Medicine, 4(1), 397–403. https://doi.org/10.21776/ub.crjim.2023.004.01.6
Ogilvie, L. M., & White, L. S. (2019). Thyroid storm: An emergency review. Emergency Medicine Journal, 36(7), 388-393.
P., McDougall, I. R., Montori, V. M., Rivkees, S. A., Ross, D. S., Sosa, J. A., & Stan, M. N. (2011). Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid, 21(6), 593–646. https://doi.org/10.1089/thy.2010.0417
Pearce, E. N., Hennessey, J. V., & McDermott, M. T. (2011). New American Thyroid Association and American Association of Clinical Endocrinologists Guidelines for Thyrotoxicosis and Other Forms of Hyperthyroidism: Significant Progress for the Clinician and a Guide to Future Research. Thyroid, 21(6), 573–576. https://doi.org/10.1089/thy.2011.0104
Woeber, K. A. (2017). Thyroid storm: A review of the literature. Endocrine Practice, 23(3), 358-365.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ni Kanaya, Borries Foresto Buharman
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
