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Elmenyar E, Aoun S, Al Saadi Z, Barkumi A, Cander B, Al-Thani H, El-Menyar A. Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock. Diagnostics (Basel) 2023; 13:3028. [PMID: 37835772 PMCID: PMC10572182 DOI: 10.3390/diagnostics13193028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch-Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.
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Affiliation(s)
- Eman Elmenyar
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Sarah Aoun
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Zain Al Saadi
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Ahmed Barkumi
- Faculty of Medicine, Internship, Bahcesehir University, Istanbul 34734, Turkey; (E.E.); (S.A.); (Z.A.S.); (A.B.)
| | - Basar Cander
- Department of Emergency Medicine, Kanuni Sultan Süleyman Training & Research Hospital, Istanbul 34303, Turkey;
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha 3050, Qatar;
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha 24144, Qatar
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Jamaluddin J, Zainal Abidin S, Kathitasapathy G, Mohamad Isa MZ, Mohamed Kamel MA, Kaur P, Palaniyappan T. ABC approach for the management of adults with hyperthyroidism: A practical strategy in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:57. [PMID: 37814670 PMCID: PMC10560458 DOI: 10.51866/rv.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Hyperthyroidism is commonly seen in primary care settings. However, the management of hyperthyroidism might be unclear to primary care doctors. Various guidelines have been published to assist clinicians in the management of thyroid disorders at various levels of care. The extensive coverage of these guidelines may not appeal to busy clinicians, and the guidelines do not focus on often resource-limited primary care settings. In this article, we aim to describe a practical guide for managing hyperthyroidism in primary care settings using an ABC approach.
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Affiliation(s)
- Jazlan Jamaluddin
- MD (Moscow), MMed (Family Medicine) (UiTM), Klinik Kesihatan Sauk, Jalan Besar, Lenggong, Sauk, Kuala Kangsar, Kuala Kangsar, Perak, Malaysia.
| | - Sofiah Zainal Abidin
- MD (UKM), MMed (Family Medicine) (UKM), Klinik Kesihatan Padang Rengas, Padang Rengas, Kuala Kangsar, Perak, Malaysia
| | - Gayathri Kathitasapathy
- MBBS (Manipal), MMed (Family Medicine) (USM), Klinik Kesihatan Karai, Enggor, Karai, Kuala Kangsar, Perak, Malaysia
| | - Mohamad Zikri Mohamad Isa
- MBBS (UiTM), MMed (Family Medicine) (UiTM), Klinik Kesihatan Lintang, Sg. Siput (U), Lintang Kuala Kangsar, Perak, Malaysia
| | - Mohd Azzahi Mohamed Kamel
- MD (Crimea), MMed (Family Medicine) (UiTM), Klinik Kesihatan Lenggong, Jalan Besar, Kampung Batu Berdinding, Lenggong, Hulu Perak, Perak, Malaysia
| | - Paream Kaur
- MBBS (Bangalore), MAFP (Malaysia), FRACGP (Australia), Klinik Kesihatan Manong, Jalan Rumah Awam II, Kuala Kangsar, Perak, Malaysia
| | - Thenmoli Palaniyappan
- MBBS (Otago), MAFP (Malaysia), FRACGP (Australia), Klinik Kesihatan Kuala Kangsar, Jalan Sultan Idris Shah 1, Kuala, Kangsar, Perak, Malaysia
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Afifi S, Suryadevara V, Habab Y, Hutcheson A, Panjiyar BK, Davydov GG, Nashat H, Ghali S, Khan S. Comparing the Incidence of Propranolol and Esmolol-Related Cardiac Arrest in Patients With Thyroid Storm: A Systematic Literature Review. Cureus 2023; 15:e44655. [PMID: 37799246 PMCID: PMC10549781 DOI: 10.7759/cureus.44655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
A precarious complication of thyrotoxicosis, or thyroid storm, is the increased risk of cardiomyopathy, which leads to circulatory collapse and cardiopulmonary arrest. It is crucial to promptly identify this condition to prevent significant deterioration of the left ventricular function and cardiogenic shock. This article seeks to examine published research that emphasizes the connection between thyroid storm and beta-blocker usage in relation to cardiogenic collapse and provides management recommendations. The search was performed on September 9, 2022, using PubMed, Science Direct, and Google Scholar libraries. A systematic exploration was carried out using the keywords Thyroid Storm AND cardiogenic Shock AND cardiac arrest AND beta blocker. The use of beta blockers as part of thyroid storm management was linked to the development of cardiogenic collapse and cardiac arrest. Ultra-short-acting beta-blockers like esmolol were a safer option than propranolol in treating patients with a thyrotoxic storm.
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Affiliation(s)
- Shadin Afifi
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Vineet Suryadevara
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Yaman Habab
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Alana Hutcheson
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Binay K Panjiyar
- Global Clinical Scholar Research Training (GCSRT), Post Graduate Medical Education (PGMEE) at Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, California, USA
| | - Gershon G Davydov
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, Soroka University Medical Center, Beer Sheva, ISR
| | - Hiba Nashat
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sally Ghali
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Bokhari SFH, Sattar H, Abid S, Vohra RR, Sajid S. Cardiovascular Collapse Secondary to Beta-Blocker Administration in a Setting of Coexisting Thyroid Storm and Atrial Fibrillation: A Case Report. Cureus 2022; 14:e29321. [PMID: 36277558 PMCID: PMC9580232 DOI: 10.7759/cureus.29321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 12/05/2022] Open
Abstract
A thyroid storm is a rare endocrinological emergency caused by severe hyperthyroidism. Reducing circulating levels of free T3 in blood and beta-adrenergic inhibition are the basis of medical treatment for thyroid storms. Propranolol, due to its additional effect of preventing the peripheral conversion of dormant T4 to active form T3, is the chosen drug for blockade in hyperthyroidism and thyroid storm. We describe a rare clinical case of cardiovascular collapse following propranolol administration in a setting of thyroid storm. The patient presented with symptoms of dyspnea and palpitations and had an ejection fraction of 10%. He was started on a calcium channel blocker (diltiazem). Further investigations revealed that the patient also had a thyroid storm and was immediately shifted to methimazole and propranolol. However, following the administration of a beta-blocker, the patient developed circulatory failure as a result of cardiac arrest, necessitating the use of vasopressors and inotropes. This implores the need for further investigations and treatment regimens for cardiovascular conditions, especially atrial fibrillation arising in thyrotoxicosis, as there are no solid treatment guides in the literature to the best of our knowledge.
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Sánchez-Pardo S, Bolívar-Mejía A, Qasem-Gómez O, García-Habeych J, Echavarria-García S. Tormenta tiroidea y terapia de intercambio plasmático. Reporte de caso. CASE REPORTS 2021. [DOI: 10.15446/cr.v7n2.90576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La tormenta tiroidea es una afectación orgánica severa que se produce por la liberación de triyodotironina (T3) y tiroxina (T4). Su incidencia es de 0.20 casos por cada 100 000 habitantes y puede conllevar a una mortalidad de hasta el 30%. Esta es una entidad refractaria para la cual existen pocas opciones terapéuticas, siendo la terapia de intercambio plasmático una estrategia potencialmente útil para su manejo.
Presentación del caso. Paciente femenina de 17 años quien ingresó al servicio de urgencias de una institución de tercer nivel de atención por un cuadro clínico de aproximadamente 25 días de evolución consistente en palpitaciones, disnea en reposo, ortopnea, dolor torácico y abdominal, astenia, adinamia, mareo, cefalea y deposiciones líquidas; como antecedentes presentaba hipertiroidismo en manejo ambulatorio. Dada la sintomatología y gracias a que se obtuvo un puntaje de 65 en la escala de Burch-Wartofsky, se diagnosticó tormenta tiroidea, se dio orden de hospitalización y se inició manejo farmacológico, con el cual no se logró una mejoría. Al tercer día de hospitalización la joven presentó deterioro clínico continuo y un episodio convulsivo, por lo que se consideró tormenta tiroidea refractaria que fue tratada satisfactoriamente con terapia de intercambio plasmático como terapia puente previo a tiroidectomía total de urgencia.
Conclusión. La terapia de intercambio plasmático permite una rápida remoción de las hormonas tiroideas y, aunque su implementación no es ampliamente difundida por las guías de práctica clínica, existe evidencia que demuestra una disminución en el riesgo de complicaciones perioperatorias y una evolución exitosa tras su uso como terapia puente previo a tiroidectomía en pacientes con tormenta tiroidea refractaria.
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