【译文】39岁女性患有周期性呕吐综合征和多种物质不耐受,因腹痛、呕吐和行为异常入院。就诊前 11周,曾因顽固性恶心和呕吐入院。症状类似于之前的周期性呕吐综合征发作,症状缓解后即出院。醒后恶心、呕吐大量暗褐色液体再次入院。入院后12个小时,持续恶心、反复呕吐,出现无力和头晕目眩。患者神志清楚,定向力存在,但情绪不稳定,时笑时哭。凝视情况加重,语速快、言语急促有时含糊不清。情绪激动,在病床上持续抖动。现体重为52.5 kg,11周前于附属医院时体重为59.3 kg。并且出现室上性心动过速。给予腺苷后,室上性心动过速缓解,显示出潜在的窦性心动过速。心动过速结合体重减轻提示甲状腺功能亢进。于是检查甲状腺功能。该患者符合严重甲状腺毒症-甲状腺风暴的标准,该病死亡率高达30%。

【原文】 A 39-year-old woman with cyclic vomiting syndrome and polysubstance use disorder presented with abdominal pain, vomiting, and odd behavior. Eleven weeks earlier, the patient was admitted to a hospital because of intractable nausea and vomiting. Her symptoms were similar to those in previous episodes that had been attributed to cyclic vomiting syndrome. The symptoms resolved and she was discharged. On the day of the current presentation, she awoke with nausea and profuse vomiting of dark-brown fluid. During the next 12 hours, she had persistent nausea and repeated episodes of vomiting. Weakness, light-headedness, and dizziness developed. On physical examination of emergency department, she was alert and oriented but had alabile affect, with alternating periods of laughing and crying. Her gaze was noted to be intense, and her speech was rapid, pressured, and at times slurred. She was agitated and was seen thrashing in her bed. The weight was 52.5 kg. At the affiliated hospital 11 weeks earlier, it had been 59.3 kg. Supraventricular tachycardia developed. After the administration of adenosine, the supraventricular tachycardia resolved, revealing underling sinus tachycardia. The combination of tachycardia and weight loss suggests hyperthyroidism. Thyroid function tests were performed. This patient met the criteria for severe thyrotoxicosis thyroidstorm, a diagnosis associated with a mortality of up to 30%.