護理師正在監測一位 6 小時前接受甲狀腺切除術的病患。病患突然出現高燒、嚴重的心跳過速與焦躁不安。護理師應優先考慮哪種併發症？
The nurse is monitoring a client who underwent a thyroidectomy 6 hours ago. The client suddenly develops a high fever, severe tachycardia, and agitation. Which complication should the nurse prioritize?
- ALaryngeal nerve damage喉返神經損傷
- BThyroid storm✓ 正解甲狀腺風暴
- CHypocalcemic tetany低血鈣性手足搐搦
- DPostoperative hemorrhage術後出血
甲狀腺風暴（Thyroid Storm）是甲狀腺手術後的一種罕見但致命的極端甲狀腺機能亢進狀態。核心概念：手術擠壓或壓力導致大量甲狀腺素（T3/T4）釋放入血，引發嚴重的代謝亢進。其經典三聯徵為：極高溫（高燒）、極度心血管負荷（嚴重過速、心律不整）以及神經系統異常（焦躁、譫妄）。這與低血鈣（手足抽搐）、出血（低血壓、頸部腫脹）或喉神經受損（聲音嘶啞）的表現截然不同。由於甲狀腺風暴可迅速導致心臟衰竭與死亡，護理師必須立即將其視為最高優先級，給予降溫處理、Beta 阻斷劑並聯絡醫療團隊進行抗甲狀腺藥物與類固醇治療。此題難度在於區分術後多種潛在急症的細微臨床表現差異。
Thyroid storm is a rare but life-threatening, extreme hyperthyroid state that can occur following thyroid surgery. Core concept: surgical manipulation or stress causes a massive release of thyroid hormones (T3/T4) into the bloodstream, triggering severe metabolic hyperactivity. The classic triad is extreme hyperpyrexia (high fever), severe cardiovascular strain (severe tachycardia, dysrhythmias), and neurological abnormalities (agitation, delirium). These features are markedly different from hypocalcemic tetany (carpopedal spasm), hemorrhage (hypotension, neck swelling), or laryngeal nerve injury (hoarseness). Because thyroid storm can rapidly progress to cardiac failure and death, the nurse must treat it as the highest priority, providing cooling measures, beta-blockers, and contacting the medical team for antithyroid therapy and corticosteroids. The difficulty of this item lies in differentiating subtle clinical presentations among several potential postoperative emergencies.
在美國臨床實務中，疑似甲狀腺風暴時護理師會立即啟動 ICU 轉床評估與冰毯降溫；台灣則較多強調傷口出血與低血鈣的監測，甲狀腺風暴因發生率極低，有時在一般病房容易被誤認為感染發燒，需更高警覺性。