Out of the blue! Thyroid crisis

Atypical presentation of thyroid storm: a diagnostic dilemma

Thyroid storm (accelerated hyperthyroidism) is an uncommon life-threatening emergency. The diagnosis is difficult and at times delayed owing to atypical presentation. Early diagnosis is the key to its successful management. We came across a patient who had presentations of acute abdomen but later diagnosed in thyroid storm. Multiorgan involvement leads all resuscitative measures futile and prevented us to salvage the patient.

Use of low-dose neostigmine intravenously in the treatment of thyroid storm-induced severe tachycardia in patient during huge pelvic mass resection: A case report and review of literature

RATIONALE

Thyroid storm is a rare and life-threatening metabolic crisis because of an emergent release of excess thyroid hormone. Sinus tachycardia induced by excess thyroid hormone may result in congestive heart failure due to decreased diastolic filling time.

PATIENT CONCERNS

A controlled hyperthyroidism patient with severe sinus tachycardia.

DIAGNOSES

A controlled hyperthyroidism patient was induced thyroid storm during huge pelvic mass resection.

INTERVENTIONS

Application of low-dose neostigmine and β-antagonist esmolol to control the heart rate (HR) avoided hemodynamic collapse.

OUTCOMES

The patient improved dramatically following application of low-dose neostigmine instead of esmolol to control the HR avoided hemodynamic collapse.

LESSONS

Our case suggests that neostigmine, an acetylcholinesterase inhibitor, may warrant further investigation in patients with thyroid storm-induced severe sinus tachycardia.