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Thyroid Storm in Head and Neck Emergency Patients. J Clin Med 2020; 9:jcm9113548. [PMID: 33158011 PMCID: PMC7692751 DOI: 10.3390/jcm9113548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Thyroid storm is a rare but life-threatening emergency that prompts urgent intervention to halt its potentially disastrous outcomes. There is not much literature available on thyroid storm in head neck trauma and non-thyroid/parathyroid head neck surgery. Due to rarity of thyroid storm in head and neck trauma/surgery patients, its diagnosis becomes challenging, is often misdiagnosed and causes delay in the diagnosis and management. Therefore, the aim of this work was to compile, analyze and present details to develop a consensus and augment available literature on thyroid storm in this group of patients. Materials and methods: A comprehensive literature search of the last 30 years was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index for thyroid storm using MeSH words and statistical analyses were performed. Results: Seven articles describing seven cases of thyroid storm were reviewed. All patients required medical management and one patient (14.3%) required adjunctive surgical management. Burch and Wartofsky Diagnostic criteria for thyroid storm were used in diagnosis of 42% patients. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation. It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality. Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient.
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Abstract
The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.
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Yatavelli RK, Levine SN. Transient Hyperthyroidism Induced by Thyroid Ultrasound. Ann Otol Rhinol Laryngol 2018; 127:558-562. [PMID: 29911397 DOI: 10.1177/0003489418781169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Transient hyperthyroidism has been documented following surgical manipulation or direct trauma to the normal thyroid gland. This has best been studied in patients following parathyroidectomy and also reported following trauma to the neck, strangulation, and vigorous palpation of the thyroid gland. It has not previously been reported following a thyroid ultrasound. METHODS We report the case of a 58-year-old euthyroid woman with a large nontoxic multinodular goiter who developed transient hyperthyroidism following an ultrasound of the thyroid gland. She was not treated with anti-thyroid medications. RESULTS Two weeks later, her free T3 and free T4 were normal, and 11 weeks after the ultrasound, all thyroid tests, including her TSH, were within the reference range. CONCLUSIONS We believe this is the first report of a euthyroid individual who developed hyperthyroidism caused by thyroid ultrasonography. We hypothesize that pressure from the ultrasound probe during the examination compressed her large nodules, releasing stored hormone.
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Affiliation(s)
- Rajini K Yatavelli
- 1 Section of Endocrinology and Metabolism, Department of Internal Medicine, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana, USA
| | - Steven N Levine
- 1 Section of Endocrinology and Metabolism, Department of Internal Medicine, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana, USA
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Wang HI, Yiang GT, Hsu CW, Wang JC, Lee CH, Chen YL. Thyroid Storm in a Patient with Trauma - A Challenging Diagnosis for the Emergency Physician: Case Report and Literature Review. J Emerg Med 2016; 52:292-298. [PMID: 27742400 DOI: 10.1016/j.jemermed.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thyroid storm, an endocrine emergency, remains a diagnostic and therapeutic challenge. It is recognized to develop as a result of several factors, including infection, surgery, acute illness, and rarely, trauma. Recognition of thyroid storm in a trauma patient is difficult because the emergency physician usually focuses on managing more obvious injuries. OBJECTIVE OF THE REVIEW We present a case of trauma-related thyroid storm and review the previous literature on posttraumatic thyroid storm to delineate risk factors of the disease. The case occurred in a 32-year-old man after a motorcycle accident. DISCUSSION Careful investigation of patient history and risk factors of trauma-related thyroid storms and utilization of the scoring system may facilitate early diagnosis. Traumatically induced thyroid storm usually responds to medical treatment developed for hyperthyroidism. Surgical intervention may be needed for patients who failed medical treatment or those with direct thyroid gland injuries. The outcome is usually fair under appropriate management. CONCLUSION We present a case of trauma-related thyroid storm to illustrate the diagnostic and therapeutic approach with a summary of the previous literature. Emergency physicians should be aware of the clinical presentation and risk factors of patients with trauma-related thyroid storm to reduce the rate of misdiagnosis and prevent catastrophic outcomes.
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Affiliation(s)
- Hsiang-I Wang
- Department of Emergency Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hsing Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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Tsukahara K, Sato K, Yumoto T, Iida A, Nosaka N, Terado M, Naito H, Orita Y, Naito T, Miki K, Sugihara M, Nagao S, Ugawa T, Nakao A. Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism. Int J Surg Case Rep 2016; 26:217-20. [PMID: 27518246 PMCID: PMC4983637 DOI: 10.1016/j.ijscr.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 11/18/2022] Open
Abstract
Massive bleeding from the thyroid without direct neck trauma rarely causes airway compromise. Physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Airway management is the most important consideration in such patients with thyroid injury.
Introduction Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. Presentation of case An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36 days after admission. Discussion Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. Conclusion Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.
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Affiliation(s)
- Kohei Tsukahara
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Keiji Sato
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tetsuya Yumoto
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Atsuyoshi Iida
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Nobuyuki Nosaka
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Michihisa Terado
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiromichi Naito
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yorihisa Orita
- Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tomoyuki Naito
- Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kentaro Miki
- Department of Otorhinolaryngology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mayu Sugihara
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Satoko Nagao
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Toyomu Ugawa
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Atsunori Nakao
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
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Avramidis S. Paranormal experience in a medico-swimming rescue: a case study. JOURNAL OF RELIGION AND HEALTH 2013; 52:408-417. [PMID: 21424176 DOI: 10.1007/s10943-011-9488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study looks at the case of a 20-year-old fisherman, who was speared in the head, the spear entering at his jaw and protruding from the top of his scull, while he was swimming unaccompanied; he was rescued, admitted to the intensive care unit for an operation, remained in a coma for a few days and then had a full recovery. About 10 days before the rescue, he had visited a monk who, intuited and functioning as channel of the divine spirit, had told him that he 'should not be afraid of anything', rubbing the top of his scull and his jaw exactly at the points through which the 40-inch spear passed. After the incident, the monk prescience again the exact day on which he would recover from the coma. It is concluded that the survival of the fisherman can be attributed to a paranormal event. The monk's prescience permit the assumption that a divine spirit was pervasive throughout the universe and present in this life-threatening situation, endeavouring to assist the lifeguard, the neurosurgeons and the young fisherman.
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Pendleton C, Mathioudakis N, Salvatori R, Quinones-Hinojosa A. "Glandular intoxication" following emergent tracheotomy during transsphenoidal surgery for acromegaly: Cushing's 1910 unrecognized case of thyroid storm? Pituitary 2012; 15:174-8. [PMID: 21394474 PMCID: PMC6121703 DOI: 10.1007/s11102-011-0301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Harvey Cushing's monograph The Pituitary Body and Its Disorders describes Case XXXVIII, H. M. B., a 33 year-old man who presented with acromegaly in 1910. The detailed operative note reports an emergency tracheotomy performed following induction of anesthesia, and immediately prior to a naso-labial approach to a suspected sellar lesion. Cushing's post-operative notes document a significant increase in temperature prior to the patient's death. Cushing offered an explanation for the patient's symptoms immediately pre-mortem, which is largely unsatisfying. Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records from the Johns Hopkins Hospital, 1896-1912, were reviewed. A review of the original surgical file revealed a more extensive description of the emergent tracheotomy required following induction of anesthesia, and provided additional information regarding the patient's symptoms in the immediate pre-mortem period. Namely, the urgent tracheotomy transected the thyroid gland, and post-operatively the patient experienced significant tachycardia and hyperthermia, consistent with thyroid storm. The new information regarding the hospital course of H. M. B. offers insight into the previously incompletely described circumstances surrounding his emergent tracheotomy, and subsequent death. Additionally, the case underscores the clinical importance of recognizing and appropriately treating thyroid storm.
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Affiliation(s)
- Courtney Pendleton
- Brain Tumor Stem Cell Laboratory, Department of Neurosurgery, Oncology and Medicine, John Hopkins School of Medicine, Baltimore, MD 21231, USA
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Raef H, Dahhan T, Ahmed M, Mubarak M, Rana T, Tulba A. Recurrent thyroid storm induced by heretofore unrecognised causes in a patient with thyroid cancer. BMJ Case Rep 2009; 2009:bcr07.2008.0442. [PMID: 21686810 DOI: 10.1136/bcr.07.2008.0442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An unusual encounter of a thyroid storm, on two separate occasions, is reported in a patient with metastatic differentiated thyroid cancer following initially direct trauma to, and later tumour embolisation of, a metastatic skeletal lesion. Shortly after a fall, our patient presented with pain and swelling in the right shoulder, high fever, change in mental status, anorexia, nausea and vomiting, tachycardia and dehydration. The laboratory tests were consistent with hyperthyroidism. As the patient improved, arterial embolisation of the large right humerus metastasis was performed to decrease the tumour burden. The patient, however, developed a similar clinical and biochemical picture to that at her presentation, with a very high free thyroxine (T(4)) level, a few days after successful embolisation. Treatment of the thyroid storm was initiated and the patient eventually improved. Awareness of such occurrences is helpful in early diagnosis and effective management of this potentially fatal complication.
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Affiliation(s)
- Hussein Raef
- King Faisal Specialist Hospital, Medicine, MBC 46, Box 3354, Takassusi Street, Riaydh, 11211, Saudi Arabia
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