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Der Nuklearmediziner 2016; 39(02): 124-131
DOI: 10.1055/s-0042-105786
Immunologische In-Vitro-Diagnostik
© Georg Thieme Verlag KG Stuttgart · New York

Thyreotoxische Krise und Myxödemkoma

Thyroid Storm and Myxedema Coma
J. W. Dietrich
1   Abteilung für Endokrinologie und Diabetologie, Medizinische Klinik I, Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum
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Publikationsdatum:
15. Juni 2016 (online)

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Zusammenfassung

Die thyreotoxische Krise und das Myxödemkoma sind Multisystemerkrankungen, die aus einem komplexen Wechselspiel aus Schilddrüsenhormonen und nicht-thyreoidalen Stressoren resultieren und unbehandelt fast immer tödlich enden. Erhöhte Konzentrationen freier Schilddrüsenhormone treffen bei der thyreotoxischen Krise auf einen vorgeschädigten oder allostatisch belasteten Organismus. Dadurch wird ein sepsisähnliches Netzwerk an positiven Rückkoppelungen entfaltet, das nur durch zügige Diagnosestellung und raschen Beginn einer intensiven polypragmatischen Therapie beherrscht werden kann. Ähnliche Überlegungen treffen für das Myxödemkoma zu: Auch hier gilt es, durch eine rechtzeitige aggressive multimodale Therapie, den Progress zu einem Multiorganversagen zu verhindern. Praxisgerechte diagnostische Werkzeuge, die in den letzten Jahren entwickelt wurden, helfen heute, frühzeitig mit einer zielgerichteten Therapie zu beginnen und damit die Prognose der beiden Schilddrüsenkrisen wesentlich zu verbessern.

Abstract

Thyroid storm and myxedema coma are multi-system diseases that result from a complex interaction among thyroid hormones and non-thyroidal strain. Without treatment they end up fatally in nearly all cases. In thyroid storm, elevated concentrations of free thyroid hormones hit an organism that is affected by diseases or subject to allostatic strain. This results in the development of a sepsis-like network of positive feedback loops, which can only be controlled by rapid diagnosis and early initiation of intensive polypragmatic therapy. Similar considerations apply to myxedema coma: Here it is necessary to stop the progress to multi-organ failure by swiftly started aggressive multimodal therapy, too. Recent years witnessed the development of feasible diagnostic tools that help to early initiate adequate therapy and to significantly improve the prognosis of both forms of thyroid crisis.

Schlüsselwörter

Schilddrüse - thyreotoxische Krise - Myxödemkoma - Hyperthyreose - Thyreotoxikose - Hypothyreose

Key words

thyroid - thyroid storm - myxedema coma - hyperthyroidism - thyrotoxicosis - hypothyroidism
 

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