51
|
Abstract
We report a case of young woman who presented with acute cardiogenic pulmonary oedema and respiratory failure. She underwent emergent endotracheal intubation and was transferred to the intensive care unit. She responded to intravenous diuretics and positive pressure ventilation. Subsequent workup revealed that she had Graves' disease and was in thyrotoxic crisis. Therapy with propranolol and propylthiouracil was instituted to which she showed remarkable improvement.
Collapse
|
52
|
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
|
53
|
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] [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
|
54
|
Bischoff A. [Endocrine emergencies. What should be done immediately so the patient survives the crisis]. MMW Fortschr Med 2011; 153:12-4, 16. [PMID: 22308583 DOI: 10.1007/bf03369189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
55
|
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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
56
|
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] [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]
|
57
|
Atri SK, Chugh SN, Goya S, Chugh K. Reversible atrioventricular blocks in thyroid storm. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2011; 59:178-179. [PMID: 21751631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
58
|
Sabnis GR, Karnik ND, Chavan SA, Korivi DS, Pati MV. Trauma precipitating thyroid storm. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2011; 59:117-119. [PMID: 21751651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
59
|
Sasaki K, Yoshida A, Nakata Y, Mizote I, Sakata Y, Komuro I. A case of thyroid storm with multiple organ failure effectively treated with plasma exchange. Intern Med 2011; 50:2801-5. [PMID: 22082892 DOI: 10.2169/internalmedicine.50.6078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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
|
60
|
Shah SN. Thyroid emergencies. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2011; 59 Suppl:66. [PMID: 21819006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
61
|
Palermo-Garófalo CA, Martínez JH, de Lourdes Miranda M, Fernández R, Viñuela A. An unusual cause of muscle weakness: a diagnostic challenge. BOLETIN DE LA ASOCIACION MEDICA DE PUERTO RICO 2011; 103:54-56. [PMID: 21696105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
62
|
Tolbert MK, Ward CR. Feline thyroid storm: rapid recognition to improve patient survival. COMPENDIUM (YARDLEY, PA) 2010; 32:E2. [PMID: 21882166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
63
|
Akamizu T. [Therapy-resistant thyroid diseases. 2. Thyrotoxic crises]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
64
|
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] [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
|
65
|
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] [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
|
66
|
Tamada N, Kasuya Y, Yorozu T, Iijima T, Iwao Y. [Case of thyroid crisis with persistent tachycardia diagnosed postoperatively]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2009; 58:1541-1544. [PMID: 20055204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
67
|
Holcomb SS. Thyroid storm. Nursing 2009; 39:72. [PMID: 19859010 DOI: 10.1097/01.nurse.0000363385.30480.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
68
|
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]. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2009; 26:665-670. [PMID: 19711739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
|
69
|
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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
70
|
Odagiri E. [Endocrine disorders (adrenal crisis and thyrotoxic crisis)]. RINSHO BYORI. THE JAPANESE JOURNAL OF CLINICAL PATHOLOGY 2009; Suppl 143:122-127. [PMID: 20845882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
71
|
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] [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]
|
72
|
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
|
73
|
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 = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2008; 43:789-790. [PMID: 19119679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
74
|
Miyazaki Y, Fukuoka K, Murase T, Yamamori I, Mano K. Abnormal MRI and EEG findings in thyroid storm resulting from Graves' disease. Thyroid 2008; 18:1131-2. [PMID: 18800874 DOI: 10.1089/thy.2007.0382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
75
|
Chiniwala NU, Woolf PD, Bruno CP, Kaur S, Spector H, Yacono K. Thyroid storm caused by a partial hydatidiform mole. Thyroid 2008; 18:479-81. [PMID: 18352822 DOI: 10.1089/thy.2007.0212] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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
|