51
|
Abstract
This review presents current knowledge about the thyroid emergencies known as myxedema coma and thyrotoxic storm. Understanding the pathogenesis of these conditions, appropriate recognition of the clinical signs and symptoms, and their prompt and accurate diagnosis and treatment are crucial in optimizing survival.
Collapse
Affiliation(s)
- Joanna Klubo-Gwiezdzinska
- Division of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010-2910, USA
| | | |
Collapse
|
52
|
Harada Y, Akiyama H, Yoshimoto T, Urao Y, Ryuzaki M, Handa M. Thyroid storm with multiple organ failure, disseminated intravascular coagulation, and stroke with a normal serum FT3 level. Intern Med 2012; 51:2379-83. [PMID: 22975553 DOI: 10.2169/internalmedicine.51.7974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Thyroid storm is a rare disorder with a sudden onset, rapid progression and high mortality. We experienced a case of thyroid storm which had a devastating course, including multiple organ failure (MOF), severe hypoglycemia, disseminated intravascular coagulation (DIC), and stroke. It was difficult to make a diagnosis of thyroid storm in the present patient, because she did not have a history of thyroid disease and her serum FT3 level was normal. Clinicians should be aware that thyroid storm can occur even when there is an almost normal level of thyroid hormones, and that intensive anticoagulation is required for patients with atrial fibrillation to prevent stroke after thyroid storm.
Collapse
Affiliation(s)
- Yuko Harada
- Department of Cardiology, Kawasaki Municipal Ida Hospital, Japan.
| | | | | | | | | | | |
Collapse
|
53
|
|
54
|
Rüthemann J. [Patient with an enlarged neck. Goiter, thyrotoxic crisis]. MMW Fortschr Med 2011; 153:5. [PMID: 22111160 DOI: 10.1007/bf03369003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
55
|
Agabiti Rosei C, Cappelli C, Salvetti M, Castellano M, Muiesan ML, Agabiti Rosei E. The unusual clinical manifestation of thyroid storm. Intern Emerg Med 2011; 6:385-7. [PMID: 21136307 DOI: 10.1007/s11739-010-0481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/29/2010] [Indexed: 11/30/2022]
|
56
|
Atri SK, Chugh SN, Goya S, Chugh K. Reversible atrioventricular blocks in thyroid storm. J Assoc Physicians India 2011; 59:178-179. [PMID: 21751631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Atrioventricular blocks or sinoatrial blocks are rarely described in patients with thyrotoxicosis or thyroid storm. The mechanism of these blocks remains obscure. Thyroid storm, being an emergency situation requires early diagnosis and management because if left untreated, it may prove fatal. Usually patients with AV blocks require pacing (temporary or permanent). Here we describe a case who developed AV blocks, did not undergo pacing, but recovered only on antithyroid treatment.
Collapse
Affiliation(s)
- Sudhir Kumar Atri
- Dept. of Medicine and Biochemistry, Pt. BD Sharma PGIMS, Rohtak, Haryana
| | | | | | | |
Collapse
|
57
|
Sabnis GR, Karnik ND, Chavan SA, Korivi DS, Pati MV. Trauma precipitating thyroid storm. J Assoc Physicians India 2011; 59:117-119. [PMID: 21751651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 40 year old male victim of a road traffic accident presented to our emergency trauma services with multiple limb injuries and a Glasgow Coma Score (GCS) of 15/15. Soon after admission, he became confused, stuporous, febrile and tachycardic. A clinical diagnosis of thyrotoxic crisis precipitated by trauma was confirmed by relevant investigations, with appropriate therapeutic response. A review of the clinical features and management of this rare medical emergency, with only few cases reported worldwide, is presented.
Collapse
Affiliation(s)
- Girish R Sabnis
- Department of Medicine, LTM Medical College and LTMG Hospital, Sion, Mumbai-400022
| | | | | | | | | |
Collapse
|
58
|
Abstract
We describe a 48-year-old man with thyroid storm presenting with heart failure. He presented severely impaired left ventricular wall motion and a marked increase in the liver enzymes. He developed disseminated intravascular coagulation on day 2. Due to elevated serum thyroid hormone level, anti-thyroid hormone receptor antibody positivity, and his clinical symptoms, he was diagnosed as thyroid storm due to untreated Graves' disease. His condition did not improve even after 6 days of conventional therapy including steroids. After therapeutic plasma exchange was carried out, his thyroid hormone level decreased markedly. Consequently, his condition recovered gradually, and he was discharged at day 43.
Collapse
Affiliation(s)
- Kazuki Sasaki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan
| | | | | | | | | | | |
Collapse
|
59
|
Shah SN. Thyroid emergencies. J Assoc Physicians India 2011; 59 Suppl:66. [PMID: 21819006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
60
|
Palermo-Garófalo CA, Martínez JH, de Lourdes Miranda M, Fernández R, Viñuela A. An unusual cause of muscle weakness: a diagnostic challenge. Bol Asoc Med P R 2011; 103:54-56. [PMID: 21696105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of 24 year-old-female presenting with bilateral leg heaviness sensation and difficult walking of one-day duration. Over the past three months she developed progressive and frequent tingling sensation on her hands accompanied by headache and increased thirst. Hypokalemia was identified and treated with resolution of symptoms. She was later found to have Graves' disease. After propranolol and radioiodine therapy no further episodes were reported. Thyrotoxic hypokalemic periodic paralysis is an alarming, potentially lethal, and rare complication of hyperthyroidism. The pathogenesis is uncertain. Because the condition is rare, it is frequently overlooked and misdiagnosed on presentation. It is important to recognize these clinical settings in hypokalemic patients in order to promptly start adequate medical therapy and avoid the lethal complications caused by prolonged sustained potassium depletion.
Collapse
|
61
|
Tolbert MK, Ward CR. Feline thyroid storm: rapid recognition to improve patient survival. Compend Contin Educ Vet 2010; 32:E2. [PMID: 21882166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In human medicine, thyroid storm is a well-recognized condition of acute thyrotoxicosis in which the patient's metabolic, thermoregulatory, and cardiovascular mechanisms are overwhelmed by excessive circulating levels of thyroid hormone. The etiology is unknown, but multiple precipitating factors have been proposed. Hyperthyroid cats presenting in thyrotoxic crisis have clinical signs similar to those of human thyroid storm patients; however, thyroid storm has not yet been fully characterized in veterinary medicine. Early recognition and prompt, appropriate treatment of this life-threatening condition are essential to obtaining a favorable outcome.
Collapse
|
62
|
Akamizu T. [Therapy-resistant thyroid diseases. 2. Thyrotoxic crises]. Nihon Naika Gakkai Zasshi 2010; 99:763-768. [PMID: 20578363 DOI: 10.2169/naika.99.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
63
|
Hartung B, Schott M, Daldrup T, Ritz-Timme S. Lethal thyroid storm after uncontrolled intake of liothyronine in order to lose weight. Int J Legal Med 2010; 124:637-40. [PMID: 20145940 DOI: 10.1007/s00414-010-0423-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 01/21/2010] [Indexed: 11/25/2022]
Abstract
Thyroid hormones are sometimes used for purposes for which they are not approved. Reasons for off-label use can be overweight, prevailing depressive mood, or various somatic symptoms. Information about the intake of thyroid hormones in order to lose weight can be easily obtained from inappropriate/nonmedical websites. The objective of this case report is to describe the first case of a lethal abuse of liothyronine. The case was a 29-year-old male (BMI 32) without relevant illnesses. An autopsy was performed and followed by histological, toxicological, and clinical chemistry examinations. The autopsy revealed no relevant pathology. Histology showed multiple areas of focal cell necrosis in the myocardium and signs of acute heart failure including severe edema of the lungs; the follicles of the thyroid gland were markedly plump. Postmortem laboratory results indicated lethal liothyronine intoxication. Despite prevailing opinion, uncontrolled intake of liothyronine can cause lethal thyroid storm in a euthyroid patient without manifested cardiac illnesses.
Collapse
Affiliation(s)
- Benno Hartung
- Institute of Legal Medicine, University Hospital Düsseldorf, 40225, Düsseldorf, Germany.
| | | | | | | |
Collapse
|
64
|
Kinoshita H, Yasuda M, Furumoto Y, Watanabe N, Horiuchi T, Murayama M, Kitamura M, Kaneko S, Inoshita S, Maruyama Y, Suenaga M, Fujita H, Fujiki K, Yakushiji F. Severe duodenal hemorrhage induced by Lugol's solution administered for thyroid crisis treatment. Intern Med 2010; 49:759-61. [PMID: 20424366 DOI: 10.2169/internalmedicine.49.2831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lugol's solution is an iodinated agent used for treating thyroid crisis. It is primarily used in diagnostic tests for esophageal diseases. However, Lugol's solution can cause local mucosal injury and hemorrhage. We report, for the first time, a case of 34-year-old man who exhibited severe duodenal hemorrhage induced by Lugol's solution that was used to treat thyroid crisis. The quantity of Lugol's solution used for treating thyroid crisis is much higher than that used for mucosal disease investigation. Clinical practitioners should be aware of gastrointestinal hemorrhage when using Lugol's solution for the treatment of thyroid crisis.
Collapse
|
65
|
Tamada N, Kasuya Y, Yorozu T, Iijima T, Iwao Y. [Case of thyroid crisis with persistent tachycardia diagnosed postoperatively]. Masui 2009; 58:1541-1544. [PMID: 20055204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 35-year-old man with multiple bone fractures underwent an emergency operation. On arriving at the operating room, his heart rate was 160 beats x min(-1), and blood pressure was 100/50 mmHg. We anesthetized him with oxygen, sevoflurane, fentanyl and remifentanil. We suspected hypovolemia, and treated him with crystalloid and transfused red cells and fresh frozen plasma so that heart rate and blood pressure could be stabilized. Tachycardia of 140 beats x min(-1) persisted, and landiolol was continuously administered at a rate of 5-10 mg x hr(-1) after a 2.5 mg bolus injection. Heart rate became controlled around 120 beats x min(-1) without hypotension during anesthesia. Finally, we noticed thyroid crisis in this case, and diagnosed it with laboratory data after operation. We should be aware that atypical tachycardia is caused by thyroid crisis.
Collapse
Affiliation(s)
- Nao Tamada
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611
| | | | | | | | | |
Collapse
|
66
|
|
67
|
Łacka K, Czyzyk A. [Diagnostic and therapeutic problems in thyrotoxic crisis in pregnant women. Influence of treatment on life and health of fetus and infant]. Pol Merkur Lekarski 2009; 26:665-670. [PMID: 19711739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Thyrotoxic crisis during pregnancy is a rare condition, but because of the danger it poses for the mother and fetus, every physician should be able to diagnose and treat it. When not recognized or incorrect treated hyperthyroidism, which is not easy to diagnose during pregnancy, is usually the basis for thyrotoxic storm. Serious conditions such as Graves' disease or multinodular goiter have to be distinguished from transient hyperthyroidism. Symptoms, such as: heat intolerance, hyperexia, emesis, tachycardia, increased pulse pressure and emotional liability should be considered cautiously because they are characteristic both for hyperthyroidism and for pregnancy. Interpretation of laboratory results need to take physiological changes during pregnancy into account--during the first trimester a low TSH serum concentration should be expected, whereas in the third trimester the free thyroxine (fT4) concentration decreases. Some conditions characteristic for pregnancy may be causative for thyrotoxic crisis: preeclampsia, placenta previa, labour induction, labour and cessarian section. Usually a hypermetabolic state has a characteristic, severe course but the possibility of monosystemic presentation must be kept in mind, because it is difficult to diagnose. Management of thyrotoxic crisis includes specific (thyrostatic agents, iodine preparations, adrenolytics, plasmaferesis) and supportive treatment. Thyrostatic agents (thiamazole and propylthiouracyl) can cross the placental barrier and similarly to iodine preparations can interfere with the pituitary-thyroid axis of the fetus. Additionally, thiamazole may cause specific embryopathy and should be considered as a second-line treatment. Adrenolytics affect the placental and uterine functions, and in high doses causes newborn hypoglycemia and bradycardia. A surgical approach is linked to an increased rate of preterm labour and miscarriage, but long-term effects are good.
Collapse
Affiliation(s)
- Katarzyna Łacka
- Uniwersytet Medyczny w Poznaniu, Katedra Endokrynologii, Przemiany Materii i Chorób Wewnetrznych.
| | | |
Collapse
|
68
|
Kokott P. [Thyrotoxic crisis]. MMW Fortschr Med 2009; 151:40. [PMID: 19827444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
69
|
Odagiri E. [Endocrine disorders (adrenal crisis and thyrotoxic crisis)]. Rinsho Byori 2009; Suppl 143:122-127. [PMID: 20845882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Emi Odagiri
- Central Clinical Laboratories, Tokyo Women's Medical University
| |
Collapse
|
70
|
Stanzani Maserati M, Faustini Fustini M. Thyroid storm with atypical neurological signs: an unusual clinical emergence of a life-threatening event. Intern Emerg Med 2009; 4:181-2. [PMID: 19089320 DOI: 10.1007/s11739-008-0218-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
|
71
|
Abstract
We describe herein a case of thyroid storm with hypoglycemia and lactic acidosis-a rare complication of thyroid storm. The patient was a 50-year-old Japanese woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: Her plasma glucose level was 14 mg/dL and her lactic acid concentration had increased to 6.238 mM. Thus, if atypical thyroid storm presents with normothermic hypoglycemia, and lactic acidosis, we believe it is necessary to consider a diagnosis of thyroid storm earlier, because this condition requires emergency treatment. Moreover, it is very important to apply standard principles in the treatment of atypical cases of thyroid storm.
Collapse
Affiliation(s)
- Kenichi Izumi
- Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan.
| | | | | |
Collapse
|
72
|
Bai YX, Ma QY, Yan LY. [Diagnosis and treatment of primary hyperparathyroidism complicated with hyperparathyroid crisis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 43:789-790. [PMID: 19119679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
73
|
|
74
|
Abstract
Clinical thyrotoxicosis is rare in molar pregnancy and has yet to be reported in a patient with a partial mole. Human chorionic gonadotropin (hCG), which has thyrotropic activity, is believed to be responsible for hyperthyroidism of gestational trophoblastic activity and hyperemesis gravidarum. We report the first case of hyperthyroidism presenting as thyroid storm in a partial molar pregnancy. Normal thyroid function returned after the partial mole was evacuated, and the biochemical improvement correlated with declining hCG levels. This case highlights the importance of including partial mole in the differential of hCG-mediated hyperthyroidism.
Collapse
Affiliation(s)
- Niyati U Chiniwala
- Department of Medicine, Crozer Chester Medical Center, Upland, Pennsylvania 19013, USA.
| | | | | | | | | | | |
Collapse
|
75
|
Abstract
A 20-year-old Somali woman presented with a tender, enlarging neck mass in the setting of weight loss and tachycardia. This was initially thought to be a thyroid storm. On further investigation, she had suppurative thyroiditis from Mycobacterium tuberculosis. This case illustrates a high prevalence of extrapulmonary tuberculosis (TB) in foreign-born individuals and the necessity to consider TB in the differential diagnosis of an enlarging neck mass.
Collapse
Affiliation(s)
- Andrea Tom
- Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, Minnesota 55902, USA
| | | | | |
Collapse
|
76
|
Abstract
UNLABELLED Timely treatment of thyroid disease during pregnancy is important in preventing adverse maternal and fetal outcome. At present, thyroid testing is performed on symptomatic pregnant women or those with a history of the disease. Hypothyroidism is very often subclinical in nature and not easily recognized without specific screening programs. Even mild maternal thyroid hormone deficiency may lead to neurodevelopment complications in the fetus. Early maternal thyroxine therapy might be beneficial in these women. The main diagnostic indicator of thyroid disease is the measurement of serum thyroid stimulating hormone and free thyroxine. Availability of gestation-age-specific thyroid stimulating hormone (TSH) thresholds is an important aid in the accurate diagnosis and treatment of thyroid dysfunction. Pregnancy-specific free thyroxine thresholds not presently available are also required. Gestational iodine deficiency is still prevalent in some areas of the United Kingdom. Thyroid peroxidase antibody (TPO Ab) in combination with thyroglobulin autoantibody (TgAb) is an accurate predictor of postpartum thyroiditis (PPT). Early screening and treatment of PPT may be justified on the grounds that it is relatively common and causes considerable postpartum morbidity. Large-scale intervention trials are urgently needed to assess the efficacy of preconception or early pregnancy screening for thyroid disorders. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to state that thyroid gland physiology changes with pregnancy, recall that levels of thyroid hormones are gestational-age related, and explain that accurate interpretation of both antepartum and postpartum levels of thyroid hormones are important in preventing pregnancy-related complication secondary to thyroid dysfunction and in the diagnosis and management of postpartum thyroiditis.
Collapse
Affiliation(s)
- Mumtaz Rashid
- Department of Obstetrics and Gynaecology, James Paget University Hospital, Gorleston, Great Yarmouth, Norfolk, NR31 6LA, United Kingdom.
| | | |
Collapse
|
77
|
Yuan YD, Seak CJ, Lin CC, Lin LJ. Thyroid storm precipitated by organophosphate intoxication. Am J Emerg Med 2007; 25:861.e1-3. [PMID: 17870509 DOI: 10.1016/j.ajem.2007.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 02/03/2007] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yao-Dong Yuan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | | | | | | |
Collapse
|
78
|
Affiliation(s)
- S Bagtharia
- Basildon University Hospital, 39 Brentwood Place, Brentwood, Essex, UK.
| | | | | | | |
Collapse
|
79
|
Abstract
A rare case of thyroid storm induced by thyroid gland injury because of penetrating neck trauma is reported. The injury was because of a spear fishing-gun trident impaction in the neck. The diagnosis of thyroid gland injury was suspected by preoperative clinical examination and established during neck exploration in the theatre. The gland injury led to thyroid storm owing to the rupture of acini and liberation of T4 into the bloodstream. Withdrawal of the impacted trident along with subtotal thyroid lobectomy and repair of soft tissue damage in addition to supported treatments, which corrected the hyperthyroid state, led to uneventful recovery.
Collapse
|
80
|
Abstract
INTRODUCTION Thyroid crisis is an acute manifestation of thyrotoxicosis. Approximately 1-2% of patients progress to a thyroid storm, often precipitated by a physiologically stressful event. If unrecognized or left untreated, thyroid storm may result in cardiovascular collapse and death. AIM We describe three patients who presented to the Emergency Department of Singapore General Hospital in a thyroid storm. They had complications of thyrocardiac disease with heart failure and arrhythmias. METHODS An analysis of case records of patients presenting to the emergency department of Singapore General Hospital with a primary diagnosis of thyrotoxicosis was made over the period of 2004-2005. Three patients with thyroid storm were identified. All the patients presented heart failure and cardiac arrhythmias (1 atrial flutter, 2 atrial fibrillation). DISCUSSION AND CONCLUSION Thyroid storm is a rare manifestation of thyrotoxicosis, usually occurring in females during the third to sixth decades of life. Serious complications such as heart failure and hypotension resulting in cardiovascular collapse and death may occur. Our case series consists of young males presenting with thyrocardiac failure. One patient was treated with beta-blockers and another with calcium channel blockers. Both developed cardiovascular collapse. The third patient was managed with digoxin with a good outcome. The current pathophysiology and therapeutic options are explored. A high index of suspicion should be maintained in young males presenting with heart failure and arrhythmia.
Collapse
Affiliation(s)
- Su Yin Adeline Ngo
- Singapore General Hospital, Department of Emergency Medicine, 3rd Hospital Avenue, Outram Raod, Singapore
| | | |
Collapse
|
81
|
Abstract
Thyroid storm is a life-threatening complication of thyroid dysfunction that is manifested by signs of cardiac arrhythmias, fever, and neurological impairment. These symptoms can easily be attributed to a multitude of factors commonly seen in neurological intensive care units, making the recognition and diagnosis of this event difficult. In this case study, a patient presents with a complicated course of hospitalization exacerbated by thyroid storm. Early nursing care and medical collaboration offset a potentially fatal condition.
Collapse
|
82
|
Nagumo K, Fukushima T, Takahashi H, Sakakibara Y, Kojima S, Akikusa B. [Thyroid crisis and protein C deficiency in a case of superior sagittal sinus thrombosis]. Brain Nerve 2007; 59:271-6. [PMID: 17370653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report the case of a 28-year-old woman who presented simultaneously with superior sagittal sinus thrombosis and thyroid crisis, and was subsequently found to have protein C deficiency. February 3, 2003, she admitted complaining of abdominal pain. The diagnosis of appendicitis was made, and she was operated on under lumbar anaesthesia. Day 7, she developed acute headache and distal weakness of the left lower limb. On examination she was alert, with a temperature of 38 degrees C, a sinus tachycardia of 124/min and blood pressure 164/84 mmHg. Neurological examination revealed neck stiffness and left hemiparesis, predominantly in her lower limb. Gadlinium-enhanced brain MRI revealed extensive superior sagittal sinus thrombosis. CT scan demonstrated infarction in the right frontal cortex, and subarachnoid hemorrhage adjacent to the right cerebellar tentorium. The patient was treated with a free radical scavenger edarabon, and glycerin. No anticoagulant therapy was instituted. Over the next 24 hours, her condition worsened. She became comatose, as well as developing a generalized tonic-clonic seizure. Day 12, laboratory examinations revealed an undetectable TSH-level CTSH (thyroid stimulating hormone) <0.005 mcIU/ml), with a level of free thyroxin 7.77 ng/dl (0.9-1.7), free triiodothyronin 29.6 pg/ml (2.3-4.3), and positive anti-TSH receptor antibodies determined subsequently. Coagulation factor VIII activity was 155% (normal range 60-150). Protein C deficiency (antigen 59%, activity 49%) was also present, suggesting a congenital type I heterozygous deficiency. A diagnosis of thyroid crisis on the basis of Graves' disease was made. The patient remained comatose and died on Day 16, with renal failure. The patient had protein C deficiency, a well-established risk factor for cerebral venous thrombosis (CVT). However, additional risk factors are required in most cases to precipitate CVT. In our case, this trigger was most likely thyroid crisis, suggesting that thyrotoxicosis, probably through hypercoagulability, may be a predisposing factor for the development of CVT.
Collapse
Affiliation(s)
- Kiyomi Nagumo
- Department of Neurology, Matsudo Municipal Hospital, 4005 Kamihongo, Matsudo, Chiba 271-8511, Japan
| | | | | | | | | | | |
Collapse
|
83
|
Morrison MP, Schroeder A. Intraoperative identification and management of thyroid storm in children. Otolaryngol Head Neck Surg 2007; 136:132-3. [PMID: 17210350 DOI: 10.1016/j.otohns.2006.06.1248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 06/14/2006] [Indexed: 11/18/2022]
|
84
|
Abstract
We describe a 47-year-old woman with severe coronary vasospasm induced by hyperthyroidism. The patient complained of anginal chest pain without specific characteristics of thyrotoxicosis. Coronary arteriography was performed and revealed 90% stenosis of both the left and right coronary os. She was treated with emergent coronary artery bypass graft surgery. Postoperatively, she exhibited a comatose mentality. Severe thyrotoxicosis was indicated on thyroid function tests and thyrotoxic storm was diagnosed. Nineteen days after the surgery and following the initiation of propylthiouracil treatment, coronary arteriography revealed entirely normal coronary arteries.
Collapse
Affiliation(s)
- Sang Min Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | | | | | | | | | | | | | | |
Collapse
|
85
|
Abstract
Thyroid storm is a rare but potentially fatal condition that is most frequently associated with Graves' disease. We present the case of a young woman who presented in thyroid storm, later diagnosed as being due to severe subacute thyroiditis. We discuss the diagnostic approach to thyroid storm, the initial management, and eventual treatment and course of subacute thyroiditis. This case illustrates the necessity to include subacute thyroiditis in the differential diagnosis of severe thyrotoxicosis and thyroid storm.
Collapse
Affiliation(s)
- Joanna L Swinburne
- Division of Endocrinology, St. Paul,s Hospital, University of British Columbia,Vancouver, British Columbia, Canada
| | | |
Collapse
|
86
|
Abstract
Thyroid storm represents the extreme manifestation of thyrotoxicosis as a true endocrine emergency. Although Grave's disease is the most common underlying disorder in thyroid storm, there is usually a precipitating event or condition that transform the patient into life-threatening thyrotoxicosis. Treatment of thyroid storm involves decreasing new hormone synthesis, inhibiting the release of thyroid hormone, and blocking the peripheral effects of thyroid hormone. This multidrug, therapeutic approach uses thionamides, iodine, beta-adrenergic receptor antagonists, corticosteroids in certain circumstances, and supportive therapy. Certain conditions may warrant the use of alternative therapy with cholestyramine, lithium carbonate, or potassium perchlorate. After the critical illness of thyroid storm subsides, definitive treatment of the underlying thyrotoxicosis can be planned.
Collapse
Affiliation(s)
- Bindu Nayak
- Department of Endocrinology, Georgetown University Hospital, Washington, DC 20007, USA.
| | | |
Collapse
|
87
|
Affiliation(s)
- Kim A Noble
- Temple University, CHP Jones Hall #415, 3307 N Broad St, Philadelphia, PA 19140, USA.
| |
Collapse
|
88
|
Fukata S. [Thyroid storm]. Nihon Rinsho 2006; Suppl 1:243-6. [PMID: 16776136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
|
89
|
Reilly Lukela J, Mangrulkar RS, Tierney LM, DelValle J, Saint S. A midlife crisis. J Hosp Med 2006; 1:200-4. [PMID: 17219494 DOI: 10.1002/jhm.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jennifer Reilly Lukela
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48108, USA.
| | | | | | | | | |
Collapse
|
90
|
Abstract
The study of endocrine emergencies in childhood is important due to their high mortality and residual morbidity, that can be reduced with an adequate diagnosis and/or therapy. In this article, we review hypoglycemia, adrenal crisis, hypocalcemia, hypercalcemia and thyroid storm in children, with focus on initial diagnostic approach and management.
Collapse
Affiliation(s)
- Consuelo Aránguiz G
- Unidad de Endocrinología, Departamento de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | |
Collapse
|
91
|
Migneco A, Ojetti V, Testa A, De Lorenzo A, Gentiloni Silveri N. Management of thyrotoxic crisis. Eur Rev Med Pharmacol Sci 2005; 9:69-74. [PMID: 15850146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The thyrotoxic crisis is a medical emergency caused by an exacerbation of the hyperthyroid state characterized by decompensation of one or more organ systems. Early recognition and aggressive treatment are fundamental in limiting the morbidity and mortality associated with this condition. The crisis has an abrupt onset, and is evoked by a precipitating factor such as infectious diseases, ketoacidosis, acute trauma, thyroidal surgery, 131-I radio-metabolic treatment, administration of iodine-containing materials (amiodarone), parturition. The clinical picture is characterized by four main features: fever, tachycardia or supraventricular arrhythmias, central nervous system symptoms and finally gastrointestinal symptoms. The diagnosis of thyrotoxic crises is often made on the basis of clinical findings alone, since it is difficult in most emergency departments to obtain rapid confirmatory laboratory or nuclear medicine tests. The ultrasound thyroid scan, if available in the emergency room, may suggest an hyperthyroid state showing typical images of Basedow's disease or nodular goiter with their characteristic color-Doppler pattern of hyperactivity, easily distinguishable from a normal gland. The principles of thyroid storm treatments are: reduction of circulating TH's levels; inhibition of the peripheral effects of circulating thyroid hormones (TH); supportive care, in order to reverse systemic decompensation and treatment of the underlying precipitating event.
Collapse
Affiliation(s)
- A Migneco
- Department of Emergency Medicine, Catholic University - Rome (Italy)
| | | | | | | | | |
Collapse
|
92
|
Abstract
A 53- year-old woman without a previous history of thyroid disease was scheduled for mastectomy. On arrival in the operating theatre unpremedicated she appeared restless and tachycardic. Midazolam and fentanyl was administered intravenously. Concomitantly, sinus tachycardia developed and a flush reaction was observed in the skin of the thoracic region and neck. The blood pressure increased to 265/160 mmHg and the patient lost consciousness and became apnoeic. Unconsciousness and apnoea lasted for approximately 25 min and the operation was postponed. Further investigations revealed an elevated serum free thyroxine level and suppressed serum thyrotropin diagnostic of hyperthyroidism. The serum TSH receptor antibody concentration was elevated, indicating that the patient was suffering from Graves' disease. We present a case of a previously unknown hyperthyroid patient, with breast cancer, presenting as a thyroid crisis on induction of anaesthesia. Although being quite a rare occurrence, unsuspected thyroid disease should be borne in mind when an agitated patient enters the operating theatre.
Collapse
Affiliation(s)
- E A Hirvonen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland.
| | | | | |
Collapse
|
93
|
Abstract
Thyrotoxicosis is a life-threatening disorder when encountered after a major surgical procedure. Plasma exchange is an occasionally reported alternative treatment to thyroidectomy, iodine ablative therapy, or the administration of thyreostatic drugs. We used plasmapheresis as a lifesaving treatment in a patient with thyrotoxicosis, as encountered after a left-sleeve pneumonectomy, in whom many classic therapies either failed or were not retained.
Collapse
Affiliation(s)
- Jurgen Petry
- Department of Intensive Care Medicine, University Hospital of Antwerp, Antwerp, Belgium
| | | | | | | |
Collapse
|
94
|
Abstract
Thyroid storm most often occurs in patients with known thyrotoxicosis. This report discusses a severe case of thyroid storm developing as a direct result of strangulation in a patient without a preexisting history of thyroid disease. Classification and treatment of this entity are discussed.
Collapse
Affiliation(s)
- Jesús I Ramírez
- Division of Trauma and Critical Care, Department of Surgery, Keck School of Medicine, University of Southern California, LAC+USC Medical Center, Los Angeles, CA 90033, USA
| | | | | | | |
Collapse
|
95
|
Charles RA, Goh SY. Not just gastroenteritis: Thyroid storm unmasked. Emerg Med Australas 2004; 16:247-9. [PMID: 15228472 DOI: 10.1111/j.1742-6723.2004.00575.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Establishing the diagnosis of thyroid storm is difficult in the ED, especially where there is no antecedent history of thyroid disease or clinical clues like goitre, exophthalmos or altered mentation, yet early recognition and treatment are essential in reducing mortality and morbidity from this endocrine emergency. We present a case where suspected infective gastroenteritis in a newly diagnosed diabetic masked the major symptomatology of thyroid storm, and review the diagnosis and management of thyrotoxic crisis.
Collapse
Affiliation(s)
- Rabind Antony Charles
- Department of Emergency Medicine, Singapore General Hospital, Singapore Health Services, Singapore.
| | | |
Collapse
|
96
|
Grimes CM, Muniz H, Montgomery WH, Goh YS. Intraoperative thyroid storm: a case report. AANA J 2004; 72:53-5. [PMID: 15098517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
An 18-year-old woman being treated for Graves disease underwent elective thyroidectomy. Tachycardia was noted before surgery. The patient's heart rate and temperature started to rise 30 minutes into surgery. Malignant hyperthermia was excluded on clinical grounds, and treatment with beta blockers was started. The patient's conditions stabilized, and surgery was completed. A review of the patient's laboratory test results revealed a high free thyroxine level before surgery. Diagnosis and management of thyroid storm are discussed.
Collapse
|
97
|
Abstract
Besides the typical and in this case severe signs of hyperthyroidism the thyrotoxic crisis is characterized by additional signs and symptoms such as fever, cardiac involvement (tachycardia, arrhythmia, heart failure) and central nervous impairment eventually leading to coma. Additional diseases and comorbidities impair the diagnostic process and may mask the symptoms of thyrotoxicosis. If undiagnosed, this situation harbors a mortality of approximately 90%. The precise knowledge of typical (and atypical) symptoms is mandatory in order to rapidly recognize this situation and to initiate pharmacological treatment and/or surgery. An experienced endocrinologist should always be involved in this decision process.
Collapse
Affiliation(s)
- K Reschke
- Klinik für Endokrinologie und Stoffwechselkrankheiten, Otto-von-Guericke-Universität Magdeburg
| | | |
Collapse
|
98
|
Abstract
We report the case of a 49-year-old woman who presented with typical features of thyroid crisis. Besides the confirmation of severe thyreotoxicosis a native valve endocarditis due to Staphylococcus aureus was diagnosed. Diagnostic criteria and therapies of these life-threatening disorders are discussed and a possible association in the present case is evaluated.
Collapse
Affiliation(s)
- C Jampen
- Medizinische Klinik, Spital Bern Ziegler
| | | | | |
Collapse
|
99
|
Abstract
We present a case of thyroid storm manifesting as supraventricular tachycardia with cardiopulmonary dysfunction. Our patient presented with severe cardiopulmonary symptoms (tachycardia, respiratory distress, and pulmonary edema) refractory to standard medical treatment. When the diagnosis of thyroid storm was made and proper treatment initiated, our patient had a prompt and appropriate response.
Collapse
Affiliation(s)
- David A Wald
- Department of Emergency Medicine, Temple University Hospital, Jones Hall 10th Floor, Ontario Street & Park Avenue, Philadelphia, PA 19140, USA
| | | |
Collapse
|
100
|
Bain S, Hamburger J. Physical signs for the general dental practitioner. Case 6: Exophthalmos. Dent Update 2003; 30:340. [PMID: 12955959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Steve Bain
- University of Birmingham School of Dentistry
| | | |
Collapse
|