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Elendu C, Amaechi DC, Amaechi EC, Chima-Ogbuiyi NL, Afuh RN, Arrey Agbor DB, Abdi MA, Nwachukwu NO, Oderinde OO, Elendu TC, Elendu ID, Akintunde AA, Onyekweli SO, Omoruyi GO. Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility - comparative review. Medicine (Baltimore) 2024; 103:e37396. [PMID: 38552097 PMCID: PMC10977538 DOI: 10.1097/md.0000000000037396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Abstract
A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are essential for patient survival. This study evaluates the utility of existing diagnostic criteria and scoring systems for thyroid storm. A comprehensive literature review encompassed articles published up to December 2023. Various diagnostic criteria and scoring systems, such as the Burch-Wartofsky Point Scale and the Japanese Thyroid Association criteria, were critically assessed based on their sensitivity, specificity, and clinical applicability. Our findings reveal that existing diagnostic criteria and scoring systems, although valuable tools, exhibit limitations. They may lack sensitivity in identifying milder cases of thyroid storm or fail to differentiate it from other critical conditions. Furthermore, some criteria rely heavily on subjective clinical Judgment, which can vary among healthcare providers. Future research should focus on refining existing criteria and developing more objective and universally applicable diagnostic tools to address these limitations. Incorporating advanced laboratory markers and modern imaging techniques may enhance diagnostic accuracy. Additionally, a standardized scoring system approach could improve clinical practice consistency. In conclusion, while current diagnostic criteria and scoring systems provide a foundation for identifying thyroid storm, their utility has shortcomings. Advancements in diagnostic methods and a collaborative effort to establish standardized criteria are imperative to enhance the accuracy and reliability of thyroid storm diagnosis, ultimately improving patient outcomes.
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Sebastian WP, Parisa A, Pandya M, Anees A. Graves' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report. Am J Case Rep 2024; 25:e941311. [PMID: 38184779 PMCID: PMC10783956 DOI: 10.12659/ajcr.941311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
BACKGROUND Since the COVID-19 pandemic, several cases of COVID-19 have been linked to the development of autoimmune disorders, including of the thyroid. Graves' disease (GD) is a rare complication that can occur following SARS-CoV-2 infection. Reports have linked COVID-19 to new onset and exacerbation of GD. We present a case of a 42-year-old woman with a history of GD presenting with impending thyroid storm 3 weeks following a diagnosis of COVID-19. CASE REPORT A 42-year-old woman with a history of GD presented to the Emergency Department (ED) for an acute exacerbation of hyperthyroidism 3 weeks after SARS-CoV-2 infection was diagnosed on a home test. Symptoms included daily headaches, increased bilateral eye pressure, fatigue, muscle weakness, episodes of confusion and agitation, persistent heart palpitations, and goiter. Elevated free T4 of 5.57, free T3 of 15.68, total T3 of 4.43, and near-absent thyroid stimulating hormone were noted. The Burch-Wartofsky scale was 40, which was concerning for an impending thyroid storm; however, at the time of admission, she was not in a thyroid storm. Treatment included propylthiouracil, potassium iodide oral solution, and propranolol, with symptom improvement. Due to prior history of intolerance to antithyroid medications and recent exacerbation, a thyroidectomy was performed once she was in a euthyroid state. CONCLUSIONS Our case demonstrates the importance of recognizing COVID-19 as an etiology or a trigger for new onset or exacerbation of GD. Our case highlights that being vigilant to recognize the association between COVID-19 and thyroid abnormalities for early diagnosis and treatment is imperative.
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Affiliation(s)
| | - Aijaz Parisa
- Department of Internal Medicine, Charleston Area Medical Center (CAMC), Charleston, WV, USA
| | - Mansi Pandya
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Amna Anees
- Department of Internal Medicine, Charleston Area Medical Center (CAMC), Charleston, WV, USA
- Department of Internal Medicine, West Virginia University – Charleston Division, Charleston, WV, USA
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Makino M, Koriyama N, Kojima N, Nishio Y. A Rare Case of Painless Destructive Thyroiditis Resulting in Thyroid Storm. Intern Med 2023; 62:3373-3379. [PMID: 37032084 DOI: 10.2169/internalmedicine.1496-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Thyroid storm is a life-threatening clinical condition that is usually triggered by untreated or interrupted treatment of Graves' disease, leading to the sudden onset of severe thyrotoxicosis, which requires an immediate diagnosis and treatment based on diagnostic criteria. Cases of thyroid storm caused by painless/painless subacute thyroiditis are very rare. We herein report an 85-year-old man with features of severe thyrotoxicosis caused by painless/painless subacute thyroiditis who had no uptake of 99mTcO4 and was negative for thyroid-stimulating hormone receptor antibodies. In thyroid storm patients in whom the findings are inconsistent with Graves' disease, careful follow-up and management are necessary, assuming the possibility of painless or painless subacute thyroiditis.
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Affiliation(s)
- Miwa Makino
- Department of Diabetes and Endocrinology, National Hospital Organization, Kagoshima Medical Center, Japan
- Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, Japan
| | - Nobuyuki Koriyama
- Department of Diabetes and Endocrinology, National Hospital Organization, Kagoshima Medical Center, Japan
| | - Nami Kojima
- Department of Diabetes and Endocrinology, National Hospital Organization, Kagoshima Medical Center, Japan
- Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, Japan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, Japan
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Pink K, Yee AC, Ha ET, Kashin M, Berson B, Peterson SJ, Alishetti S, Aronow W, Ramasubbu K. Risk factors for cardiogenic shock in thyroid storm: a retrospective and case-series study. Future Cardiol 2023; 19:605-613. [PMID: 37830335 DOI: 10.2217/fca-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Aim: Thyroid storm (TS) occurs in 10% of thyrotoxicosis patients and 1% of TS patients experience cardiogenic shock (CS), which is associated with poor prognosis. Methods: This is a single institution, retrospective study in which 56 patients with TS were evaluated. Results: BMI (p = 0.002), history of heart failure (OR 8.33 [1.91, 36.28]; p = 0.004), pro-BNP elevation (p = 0.04), chest x-ray showing interstitial edema (OR 3.33 [1.48, 7.52]; p = 0.01) and Burch-Wartofsky score (62.5 vs 40; p = 0.004) showed association with CS. CS patients had increased length of stay (16.5 vs 4 days; p = 0.01) and higher in-hospital mortality (OR 24.5 [2.90, 207.29]; p < 0.001). Conclusion: These risk factors are useful to risk stratify TS patients on admission, institute therapy in a timely manner and decrease mortality.
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Affiliation(s)
- Kevin Pink
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Aaron C Yee
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Edward T Ha
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Maxim Kashin
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Benjamin Berson
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Stephen J Peterson
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Shudhanshu Alishetti
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
| | - Wilbert Aronow
- Department of Cardiology, New York Medical College, Valhalla, NY, 10595, USA
| | - Kumudha Ramasubbu
- Department of Internal Medicine & Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215 USA
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Eltahir M, Chaudhry H, Ibrahim EA, Mokhtar M, Jaouni H, Hassan IF, El-Menyar A, Shehatta AL. Thyroid Storm-Induced Refractory Multiorgan Failure Managed by Veno-Arterial Extracorporeal Membrane Oxygenation Support: A Case-Series. Am J Case Rep 2023; 24:e940672. [PMID: 37614021 PMCID: PMC10461322 DOI: 10.12659/ajcr.940672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 06/22/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Severe hyperthyroidism, including thyroid storm, can be precipitated by acute events, such as surgery, trauma, infection, medications, parturition, and noncompliance or stoppage of antithyroid drugs. Thyroid storm is one of the serious endocrinal emergencies that prompts early diagnosis and treatment. Early occurrence of multiorgan failure is an ominous sign that requires aggressive treatment, including the initiation of extracorporeal membrane oxygenation (ECMO) support as a bridge to stability and definitive surgical treatment. Most adverse events occur after failure of medical therapy. CASE REPORT We described 4 cases of fulminating thyroid storm that were complicated with multiple organ failure and cardiac arrest. The patients, 3 female and 1 male, were between 39 and 46 years old. All patients underwent ECMO support, with planned thyroidectomy. Three survived to discharge and 1 died after prolonged cardiac arrest and sepsis. All patients underwent peripheral, percutaneous, intensivist-led cannulation for VA-ECMO with no complications. CONCLUSIONS Early recognition of thyroid storm, identification of the cause, and proper treatment and support in the intensive care unit is essential. Patients with thyroid storm and cardiovascular collapse, who failed to improve with conventional supportive measures, had the worst prognosis, and ECMO support should be considered as a bridge until the effective therapy takes effect. Our case series showed that, in patients with life-threatening thyroid storm, VA-ECMO can be used as bridge to stabilization, definitive surgical intervention, and postoperative endocrine management. Interprofessional team management is essential, and early implantation of VA-ECMO is likely beneficial in patients with thyroid storm after failure of conventional management.
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Affiliation(s)
- Mugahid Eltahir
- Department of Internal Medicine, Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamza Chaudhry
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Ezzeddin Abdulsalam Ibrahim
- Department of Internal Medicine, Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Marwa Mokhtar
- Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hani Jaouni
- Department of Internal Medicine, Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Ibrahim Fawzy Hassan
- Department of Internal Medicine, Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Labib Shehatta
- Department of Internal Medicine, Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
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Farooqi S, Raj S, Koyfman A, Long B. High risk and low prevalence diseases: Thyroid storm. Am J Emerg Med 2023; 69:127-135. [PMID: 37104908 DOI: 10.1016/j.ajem.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Thyroid storm is a rare but serious condition that carries a high rate of morbidity and even mortality. OBJECTIVE This review highlights the pearls and pitfalls of thyroid storm, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Thyroid storm is a challenging condition to diagnose and manage in the ED. It is characterized by exaggerated signs and symptoms of thyrotoxicosis and evidence of multiorgan decompensation, usually occurring in the presence of an inciting trigger. Clinical features of thyroid storm may include fever, tachycardia, signs of congestive heart failure, vomiting/diarrhea, hepatic dysfunction, and central nervous system disturbance. There are several mimics including sympathomimetic overdose, substance use disorders, alcohol withdrawal, acute pulmonary edema, aortic dissection, heat stroke, serotonin syndrome, and sepsis/septic shock. Ultimately, the key to diagnosis is considering the disease. While laboratory assessment can assist, there is no single laboratory value that will establish a diagnosis of thyroid storm. Clinical criteria include the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria. ED treatment focuses on diagnosing and managing the trigger; resuscitation; administration of steroids, thionamides, iodine, and cholestyramine; and treatment of hyperthermia and agitation. Beta blockers should be administered in the absence of severe heart failure. The emergency clinician should be prepared for rapid clinical deterioration and employ a multidisciplinary approach to treatment that involves critical care and endocrinology specialists. CONCLUSIONS An understanding of thyroid storm can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Samia Farooqi
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Sonika Raj
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Sneyers Closa M, Pérez Requena A, Sánchez García S, Sistac Ballarín J. Anaesthetic management of thyroid storm in a patient with Friederich's ataxia. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:362-365. [PMID: 37276964 DOI: 10.1016/j.redare.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/02/2022] [Indexed: 06/07/2023]
Abstract
A 26-year-old patient with Friederich's ataxia with hypertrophic obstructive cardiomyopathy undergoing total thyroidectomy due to persistent amiodarone-induced thyrotoxicosis (despite high doses of antithyroid drugs and corticosteroids), presented an intraoperative episode suggestive of thyroid storm. Thyroid storm is an endocrine emergency that is associated with high morbidity and mortality. Early diagnosis and treatment, which is of vital importance to improve survival, includes symptomatic treatment, treatment of cardiovascular, neurological, and/or hepatic manifestations and thyrotoxicosis, measures to suppress or avoid triggering stimuli, and definitive treatment.
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Affiliation(s)
- M Sneyers Closa
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - A Pérez Requena
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - S Sánchez García
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Sistac Ballarín
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Pagán-Rappo MJ, Jurado-Fernández de Lara CE, Castro-Sánchez O, Carpio-Vargas KY, Gutiérrez-Riveroll KI. [Multimodal anesthesia in a patient with Graves' disease and thyrotoxicosis: A case report]. Rev Med Inst Mex Seguro Soc 2022; 60:584-590. [PMID: 36049082 PMCID: PMC10395889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hyperthyroidism is the increase in the synthesis and secretion of thyroid hormones. It is rare but serious in children and constitutes approximately 5% of all cases; 15% manifests before 10 years of age. The peak of presentation and the majority of cases (80%) are diagnosed around 10-15 years of age. Adolescence is usually the stage with the highest incidence and it is more frequent in women (5:1). Acute thyrotoxic crisis or thyroid storm is rare and only occurs in a poorly controlled hyperthyroid patient or in a hyperthyroid patient undergoing emergency surgery. It is manifested by fever, extreme tachycardia, tachyarrhythmia with atrial fibrillation, vomiting, diarrhea, agitation and mental confusion. CLINICAL CASE 17-year-old adolescent with Graves' disease with uncontrolled clinical manifestations that did not respond to medical treatment and was scheduled for radical thyroidectomy. 35 points were obtained on the Burch and Wartofsky Scale. It was managed with general anesthesia, reducing stimuli for airway and regional control to reduce surgical stimuli. Adjuvant medications such as magnesium sulfate for intraoperative stability were used. CONCLUSION Multimodal anesthesia managed to avoid thyroid storm, postoperative pain, as well as other complications.
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Affiliation(s)
- María José Pagán-Rappo
- Secretaría de Salud, Hospital Para el Niño Poblano, Servicio de Anestesiología Pediátrica. Puebla, Puebla, México
| | | | - Olga Castro-Sánchez
- Secretaría de Salud, Hospital de Alta Especialidad de Veracruz, Servicio de Anestesiología. Veracruz, Veracruz, México
| | - Karen Yarivani Carpio-Vargas
- Secretaría de Salud, Hospital Para el Niño Poblano, Servicio de Anestesiología Pediátrica. Puebla, Puebla, México
| | - Karla Itzel Gutiérrez-Riveroll
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital General "Dr. Gaudencio González Garza", Servicio de Anestesiología Pediátrica. Ciudad de México, México
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Cai Y, Ren L, Liu X, Li C, Gang X, Wang G. Thyroid storm complicated by corpus callosum infarction in a young patient: A case report and literature review. Medicine (Baltimore) 2022; 101:e30318. [PMID: 36042649 PMCID: PMC9410692 DOI: 10.1097/md.0000000000030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Thyroid storm (TS) is a rare life-threatening hypermetabolic thyrotoxicosis with an incidence of 0.57-0.76/100,000. The coexistence of TS and acute cerebral infarction is rare. Previous studies have shown that hyperthyroidism complicated by cerebral infarction mainly occurs in the intracranial basal ganglia; however, there are no reports of corpus callosum infarction. We report a case of TS complicated by cerebral infarction of the corpus callosum at our hospital. PATIENT CONCERNS A 31-year-old male patient with a history of hyperthyroidism was admitted to the hospital because of fatigue, palpitations, fever, and profuse sweating accompanied by a mild decrease in the muscle strength of the left limb. Diagnosis of a TS was confirmed by the laboratory test results. The patient's clinical symptoms gradually improved after treatment. However, his left limb muscle strength progressively decreased, and the bilateral pathological signs were positive at the same time. Magnetic resonance imaging (MRI) of the head revealed acute cerebral infarction of the corpus callosum and pons. DIAGNOSIS The diagnosis was thyroid strom with acute cerebral infarction of the corpus callosum and pons and severe stenosis or occlusion of the basilar artery. INTERVENTIONS The patient was given 300 mg hydrocortisone intravenously per day, propylthiouracil tablets of 200 mg 3 times a day by nasal feeding, and 20 mg propranolol three times a day by nasal feeding. Aspirin and clopidogrel were administered to prevent platelet aggregation, and atorvastatin calcium was administered to lower lipid levels to stabilize plaques. OUTCOMES The patient's left limb muscle strength recovered to grade 4+, and he could walk beside the bed with support. Simultaneously, thyroid function was better than before. LESSONS Careful physical examination should be performed in patients with thyroid storm, and head imaging examination should be improved for the early detection of cerebral infarction.
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Affiliation(s)
- Yunjia Cai
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
| | - Linan Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
| | - Xinming Liu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
| | - Chen Li
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun 130021, China
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De Almeida R, McCalmon S, Cabandugama PK. Clinical Review and Update on the Management of Thyroid Storm. Mo Med 2022; 119:366-371. [PMID: 36118802 PMCID: PMC9462913] [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: 06/15/2023]
Abstract
Thyroid storm is a severe manifestation of thyrotoxicosis. Thyroid storm is diagnosed as a combination of thyroid function studies showing low to undetectable thyroid stimulating hormone (TSH) (<0.01mU/L) with elevated free thyroxine (T4) and/or triiodothyronine (T3), positive thyroid receptor antibody (TRab) (if Graves' disease is the underlying etiology), and with clinical signs and symptoms of end organ damage. Treatment involves bridging to a euthyroid state prior to total thyroidectomy or radioactive iodine ablation to limit surgical complications such as excessive bleeding from highly vascular hyperthyroid tissue or exacerbation of thyrotoxicosis. The purpose of this article is a clinical review of the various treatments and methodologies to achieve a euthyroid state in patients with thyroid storm prior to definitive therapy.
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Affiliation(s)
- Reuben De Almeida
- Internal Medicine Resident, University of Missouri-Kansas City-School of Medicine (UMKC-SOM), Kansas City, Missouri
| | - Sean McCalmon
- Endocrinology Fellow at UMKC-SOM, Kansas City, Missouri
| | - Peminda K Cabandugama
- Assistant Professor of Medicine and Faculty Member of the Endocrinology Fellowship Program at the UMKC-SOM, Kansas City, Missouri
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Nasrullah A, Azharuddin S, Young M, Kejas A, Dumont T. Endocrine Emergencies in the Medical Intensive Care Unit. Crit Care Nurs Q 2022; 45:266-284. [PMID: 35617093 DOI: 10.1097/cnq.0000000000000411] [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: 11/25/2022]
Abstract
Endocrine emergencies are underdiagnosed and often overlooked amid the management of severe multisystem pathologies in critically ill patients in the medical intensive care unit (ICU). In an appropriate clinical scenario, a low threshold of suspicion should be kept to investigate for various life-threatening, yet completely treatable, endocrinopathies. Prompt identification and treatment of endocrine emergencies such as diabetic ketoacidosis, myxedema coma, thyroid storm, and/or adrenal insufficiency leads to fewer complications, shorter ICU and hospital stay, and improved survival. This review article entails common endocrine emergencies encountered in the ICU and addresses their epidemiology, pathophysiology, clinical presentation and management.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Nasrullah, Azharuddin, Young, and Dumont); and Department of Nursing, Allegheny Health Network, Pittsburgh, Pennsylvania (Ms Kejas)
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12
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Al-Mashdali AF, Gul M, Umer W, Omar A, Jones A. Non-diabetic ketoacidosis secondary to primary hyperthyroidism: A case report. Medicine (Baltimore) 2022; 101:e28253. [PMID: 35687767 PMCID: PMC9276427 DOI: 10.1097/md.0000000000028253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/04/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION There are variable complications of hyperthyroidism, including atrial fibrillation, heart failure, osteoporosis, and thyroid storm. One infrequent complication of hyperthyroidism is non-diabetic ketoacidosis (NDKA). To the best of our knowledge, our case is the third report of NDKA related to thyrotoxicosis. PATIENT CONCERN We describe a case of a 41-year-old African lady with no past medical history presented to our hospital with severe abdominal pain and vomiting for three weeks. This was associated with decreased appetite and weight loss. DIAGNOSIS Laboratory findings were significant for high anion gap metabolic acidosis, positive ketones in the urine, and high serum B-hydroxybutyrate. The blood glucose readings and HbA1c were within normal limits. Also, serum lactic acid and salicylate levels were within the normal range. The diagnosis of NDKA was made. Later, the thyroid functions test (TFT) confirmed the diagnosis of primary hyperthyroidism. INTERVENTION AND OUTCOMES The patient was managed initially with intravenous fluid and antiemetics. Then, she was started on propranolol and carbimazole. After which, her symptoms improved dramatically, and the metabolic acidosis (with serum ketones) were corrected within a few days of starting anti-thyroid medications. CONCLUSION Despite its rarity, NDKA can be associated with severe thyrotoxicosis. Vigorous intravenous hydration and anti-thyroid medication are the mainstay treatment. TFT should be requested in a patient with unexplained NDKA.
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Affiliation(s)
| | - Mohammadshah Gul
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Waseem Umer
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abeer Omar
- College of Medicine, Qatar University, Doha, Qatar
| | - Akhnuwkh Jones
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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13
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Muscoli S, Lecis D, Prandi FR, Ylli D, Chiocchi M, Cammalleri V, Lauro D, Andreadi A. Risk of sudden cardiac death in a case of spontaneous coronary artery dissection presenting with thyroid storm. Eur Rev Med Pharmacol Sci 2022; 26:3712-3717. [PMID: 35647853 DOI: 10.26355/eurrev_202205_28867] [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: 06/15/2023]
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is a spontaneous separation of the coronary artery wall whose etiology appears to be poorly understood. SCAD is a rare cause of acute coronary syndromes, and it is a life-threatening condition. CASE REPORT We report the case of a young woman who developed SCAD during a thyroid storm (TS). RESULTS To the best of our knowledge, this is the first reported case of SCAD during a TS, and it suggests a possible association between high levels of circulating thyroid hormones and SCAD susceptibility. CONCLUSIONS Early identification of SCAD predisposing factors is important to identify high-risk patients. In patients presenting to the emergency department because of chest pain with a history of dysthyroidism, early determination of thyroid hormones and troponin could prevent certain forms of sudden cardiac death.
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Affiliation(s)
- S Muscoli
- Division of Cardiology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Chen YH, Liao CP, Lu CW, Lin TY, Chang YY. Thyroid Storm Superimposed on Gestational Hypertension: A Case Report and Review of Literature. Medicina (B Aires) 2022; 58:medicina58030450. [PMID: 35334626 PMCID: PMC8951575 DOI: 10.3390/medicina58030450] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
A thyroid storm is an extreme manifestation of thyrotoxicosis, and is life threatening without an early diagnosis. Pregnancy or childbirth may worsen maternal hyperthyroidism or induce the development of a thyroid storm. Gestational hypertension, a disorder defined as new-onset hypertension, develops after 20 weeks of gestation and shares symptoms with a thyroid storm. The diagnosis of a thyroid storm may be challenging in patients with gestational hypertension. To highlight the significance of early thyrotoxicosis-related gastrointestinal symptoms, we report a case of a 38-year-old woman with a twin pregnancy, who was diagnosed with gestational hypertension, and then developed a thyroid storm during the peripartum period. She complained of nausea and abdominal pain, followed by tachycardia, hypertension, and a disturbance of consciousness with desaturation. After emergency caesarean section, fever, diarrhea, and high-output heart failure, with pulmonary edema, were noted during the postoperative period in the intensive care unit. The diagnosis of a thyroid storm was confirmed using the Burch–Wartofsky point scale, which was 75 points. In this patient, the uncommon gastrointestinal symptoms, as initial manifestations of thyrotoxicosis, indicated the development of a thyroid storm. The distinguished presentation of thyrotoxicosis-induced cardiomyopathy and peripartum cardiomyopathy also helped in the differential diagnosis between a thyroid storm and gestational hypertension. Aggressive treatment for thyrotoxicosis should not be delayed because of a missed diagnosis.
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Affiliation(s)
- Yen-Hua Chen
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (Y.-H.C.); (C.-P.L.); (C.-W.L.); (T.-Y.L.)
| | - Chan-Pin Liao
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (Y.-H.C.); (C.-P.L.); (C.-W.L.); (T.-Y.L.)
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (Y.-H.C.); (C.-P.L.); (C.-W.L.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Zhongli 320315, Taiwan
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (Y.-H.C.); (C.-P.L.); (C.-W.L.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Zhongli 320315, Taiwan
| | - Ya-Ying Chang
- Department of Anesthesiology, Far-Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (Y.-H.C.); (C.-P.L.); (C.-W.L.); (T.-Y.L.)
- International Program in Engineering for Bachelor, Yuan Ze University, Zhongli 320315, Taiwan
- Correspondence: ; Tel.: +886-2-89667000-2385
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15
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Tsang DA, Tan YH. Acute hypercapnic respiratory failure in thyroid storm and the role of plasma exchange. Ann Acad Med Singap 2022; 51:186-188. [PMID: 35373243 DOI: 10.47102/annals-acadmedsg.2021423] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Denise Ann Tsang
- Department of Internal Medicine, Singapore General Hospital, Singapore
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Iino T, Akatsuka M, Yamamoto S. Case Report: Occurrence of Thyroid Storm in a Young Patient With Recurrent Diabetic Ketoacidosis. Front Endocrinol (Lausanne) 2022; 13:834505. [PMID: 35370958 PMCID: PMC8964785 DOI: 10.3389/fendo.2022.834505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thyroid storm (TS) is a fatal disease that leads to multiple organ failure and requires prompt diagnosis. Diabetic ketoacidosis (DKA) is a trigger for thyroid crisis. However, TS and DKA rarely occur simultaneously. Moreover, owing to the rarity of the co-occurrence, the clinical course remains unclear. In this study, we present a case of TS that developed during the follow-up for repeated DKA in a young patient. CASE PRESENTATION A 25-year-old man with a history of recurrent DKA was brought to the emergency room frequently with similar symptoms. DKA treatment was initiated, but his tachycardia and disturbance of consciousness did not improve. Further examination of the patient revealed a Burch-Wartofsky Point Scale score of 80 points, consistent with the Japan Thyroid Association criteria. Therefore, DKA coexisting with TS was diagnosed. Antithyroid medication, inorganic iodine, and corticosteroids were then started as treatment for TS, and β-blockers were administered to manage tachycardia. With these treatments, the patient's health improved and he recovered. CONCLUSIONS In severe cases of recurrent DKA, the presence of TS should be considered, and early treatment should be initiated before the patient's condition worsens.
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Keyai NK, Nepal N, Khanal S. Thyroid storm presenting as septic shock in the intensive care unit: A Case Series. JNMA J Nepal Med Assoc 2020. [PMID: 32335640 PMCID: PMC7580483 DOI: 10.31729/jnma.4552] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Thyroid storm is a rare endocrine emergency that rarely presents with septic shock. It occurs in thyrotoxic patients and is manifested by decompensation of multiple organs, triggered by severe stress. The diagnosis and response to treatment is made by Burch-Wartofsky point scale or Japanese thyroid association criteria due to lack of pathophysiology of thyroid storm. We reported series of patients that presented with altered sensorium, cough, fever, palpitation, shortness of breath and shock. Patient were treated initially for septic shock, later diagnosed as thyroid storm and was treated with oral carbimazole, propanolol and digoxin. From this, we want to emphasize that thyroid storm can have any presentation that should be kept in differential diagnosis of septic shock not responding to usual treatment; early diagnosis and treatment with oral medication can decrease morbidity and mortality in rural setting where intravenous form of antithyroid drug are not available for thyroid storm.
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Affiliation(s)
- Niraj Kumar Keyai
- Department of Critical Care Medicine, B&C Medical College and Teaching Hospital, Birtamode, Nepal
- Correspondence: Dr. Niraj Kumar Keyal, Department of Critical Care Medicine, B&C Medical College and Teaching Hospital, Birtamode, Nepal. , Phone: +977-9855027141
| | - Niru Nepal
- Department of Anaesthesia & Critical Care, B&C Medical College Teaching Hospital, Birtamode, Nepal
| | - Sudesh Khanal
- Department of Critical Care Medicine, B&C Medical College and Teaching Hospital, Birtamode, Nepal
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18
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Tomschik M, Koneczny I, Schötta AM, Scharer S, Smajlhodzic M, Rosenegger PF, Blüthner M, Höftberger R, Zimprich F, Stanek G, Markowicz M. Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans. Emerg Infect Dis 2019; 25:968-971. [PMID: 31002066 PMCID: PMC6478190 DOI: 10.3201/eid2505.181591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report the rapid development of a myasthenic crisis as the first-time manifestation of myasthenia gravis. The symptoms developed in the course of acute leptospirosis associated with a new sequence type of Leptospira interrogans. Antibiotic treatment led to rapid amelioration of myasthenia.
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Tengku Ibrahim TZ, Thambiah SC, Samsudin IN, Nasuruddin AN, Zakaria MH. Thyroid storm: Is there a role for thyroid function test? Malays J Pathol 2019; 41:355-358. [PMID: 31901922] [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: 06/10/2023]
Abstract
INTRODUCTION Thyroid storm (TS) is an endocrine emergency. Early diagnosis for prompt treatment is essential as it has a high mortality rate. CASE REPORT A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure. DISCUSSION Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient's TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.
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Affiliation(s)
- T Z Tengku Ibrahim
- Universiti Putra Malaysia, Faculty of Medicine & Health Sciences, Department of Pathology, Serdang, Malaysia.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- 1Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Charles H Emerson
- 2Department of Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts
| | - Douglas S Ross
- 3Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Peter A Kopp
- 4Division of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Elizabeth N Pearce
- 5Boston University School of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston, Massachusetts
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21
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Ishihara Y, Sugawa T, Kaneko H, Hiroshima-Hamanaka K, Amano A, Umakoshi H, Tsuiki M, Kusakabe T, Satoh-Asahara N, Shimatsu A, Tagami T. The Delayed Diagnosis of Thyroid Storm in Patients with Psychosis. Intern Med 2019; 58:2195-2199. [PMID: 30996193 PMCID: PMC6709321 DOI: 10.2169/internalmedicine.2681-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We herein report two cases of patients with thyroid storm with a delayed diagnosis due to psychosis. The patients were a 63-year-old woman with bipolar II disorder and a 37-year-old man with major depressive disorder. The psychoses in both patients were well controlled with medication. Although they both showed symptoms of thyrotoxicosis, the symptoms were ignored, presumably because the psychological manifestations of worsening of psychosis and thyroid storm are similar. When the mental or physical state of patients with psychosis changes, thyroid hormone levels should be measured for early treatment.
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Affiliation(s)
- Yuki Ishihara
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Taku Sugawa
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Hiroki Kaneko
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Kaho Hiroshima-Hamanaka
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Aya Amano
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Hironobu Umakoshi
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Akira Shimatsu
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Tetsuya Tagami
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
- Department of Endocrinology, Metabolism, and Hypertension Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
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22
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Dietrich JW, Barkhoff K. [Thyroid storm]. MMW Fortschr Med 2019; 161:54-55. [PMID: 31079368 DOI: 10.1007/s15006-019-0514-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Johannes W Dietrich
- Medizinische Klinik I, BG Universitätsklinikum Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, D-44789, Bochum, Deutschland.
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23
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Abstract
Thyroid emergencies are rare life-threatening endocrine conditions resulting from either decompensated thyrotoxicosis (thyroid storm) or severe thyroid hormone deficiency (myxedema coma). Both conditions develop out of a long-standing undiagnosed or untreated hyper- or hypothyroidism, respectively, precipitated by an acute stress-associated event, such as infection, trauma, or surgery. Cardinal features of thyroid storm are myasthenia, cardiovascular symptoms, in particular tachycardia, as well as hyperthermia and central nervous system dysfunction. The diagnosis is made based on clinical criteria only as thyroid hormone measurements do not differentiate between thyroid storm and uncomplicated hyperthyroidism. In addition to critical care measures therapy focusses on inhibition of thyroid hormone synthesis and secretion (antithyroid drugs, perchlorate, Lugol's solution, cholestyramine, thyroidectomy) as well as inhibition of thyroid hormone effects in the periphery (β-blocker, glucocorticoids).Cardinal symptoms of myxedema coma are hypothermia, decreased mental status, and hypoventilation with risk of pneumonia and hyponatremia. The diagnosis is also purely based on clinical criteria as measurements of thyroid hormone levels do not differ between uncomplicated severe hypothyroidism and myxedema coma. In addition to substitution of thyroid hormones and glucocorticoids, therapy focusses on critical care measures to treat hypoventilation and hypercapnia, correction of hyponatremia and hypothermia.Survival of both thyroid emergencies can only be optimized by early diagnosis based on clinical criteria and prompt initiation of multimodal therapy including supportive measures and treatment of the precipitating event.
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Affiliation(s)
- C Spitzweg
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.
| | - M Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - R Gärtner
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
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24
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Hessulf F, Håkansson D, Nilsson M, Ribom-Bornefalk E. [Thyroid storm and diabetic ketoacidosis (DKA) in a previously healthy male - a significant differential diagnostic challenge]. Lakartidningen 2018; 115:E9EY. [PMID: 30152853] [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: 06/08/2023]
Abstract
Thyroid storm is a potentially lethal condition sometimes seen in cases of untreated thyrotoxicosis. Hypermetabolism, fever, and tachycardia are typical symptoms of the increased thyroid hormone activity. Thyroid storm is often triggered by infection, trauma or recent surgery and rarely by other causes. We present a case of thyroid storm and diabetic ketoacidosis (DKA) in a previously healthy male. After extensive lab testing, the patient was found to have both an undiagnosed type 1 diabetes and Graves disease. This combination of underlying conditions and the combined presentation of thyroid storm and DKA pose a significant differential diagnostic challenge, and this case report reminds us to think broadly when presented with an atypical case.
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Affiliation(s)
- Fredrik Hessulf
- Goteborgs universitet Avdelningen for molekylar och klinisk medicin - Institutionen för Medicin Goteborg, Sweden - Halmstad, Sweden
| | - Daniel Håkansson
- Hallands sjukhus Halmstad - Operations och Intensivvårdskliniken Halmstad, Sweden Hallands sjukhus Halmstad - Operations och Intensivvårdskliniken Halmstad, Sweden
| | - Måns Nilsson
- Hallands sjukhus Halmstad - Operations och Intensivvårdskliniken Halmstad, Sweden - Operations-och intensivvårdsenheten, Hallands sjukhus Halmstad Halmstad, Sweden
| | - Eva Ribom-Bornefalk
- Medicinkliniken, Hallands sjukhus Halmstad - Halmstad, Sweden Medicinkliniken, Hallands sjukhus Halmstad - Halmstad, Sweden
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25
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Rastogi V, Singh D, Mazza JJ, Parajuli D, Yale SH. Flushing Disorders Associated with Gastrointestinal Symptoms: Part 2, Systemic Miscellaneous Conditions. Clin Med Res 2018; 16:29-36. [PMID: 29650526 PMCID: PMC6108508 DOI: 10.3121/cmr.2017.1379b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
Flushing disorders with involvement of the gastrointestinal tract represent a heterogeneous group of conditions. In part 1 of this review series, neuroendocrine tumors (NET), mast cell activation disorders (MCAD), and hyperbasophilia were discussed. In this section we discuss the remaining flushing disorders which primarily or secondarily involve the gastrointestinal tract. This includes dumping syndrome, mesenteric traction syndrome, rosacea, hyperthyroidism and thyroid storm, anaphylaxis, panic disorders, paroxysmal extreme pain disorder, and food, alcohol and medications. With the exception of paroxysmal pain disorders, panic disorders and some medications, these disorders presents with dry flushing. A detailed and comprehensive family, social, medical and surgical history, as well as recognizing the presence of other systemic symptoms are important in distinguishing the different disease that cause flushing with gastrointestinal symptoms.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida College of Medicine/HCA, Consortium Graduate Medical Education, North Florida, Regional Medical Center, 6500 W Newberry Rd, Gainesville, FL 32605
- University of Central Florida College of Medicine, 6850, Lake Nona Blvd, Orlando, FL 32827
| | - Devina Singh
- Feinstein Institute for Medical Research, 350 Community, Dr. Manhasset, NY 11030
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, 1000 North Oak, Avenue, Marshfield, WI 54449
| | - Dipendra Parajuli
- University of Louisville, Department of Medicine, Gastroenterology, Hepatology and Nutrition. Director, Fellowship Training Program, Director, Medical Procedure Unit Louisville VAMC 401 East Chestnut Street, Louisville, KY 40202
| | - Steven H Yale
- University of Central Florida College of Medicine/HCA, Consortium Graduate Medical Education, North Florida, Regional Medical Center, 6500 W Newberry Rd, Gainesville, FL 32605.
- University of Central Florida College of Medicine, 6850, Lake Nona Blvd, Orlando, FL 32827
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Abstract
BACKGROUND Thyroid storm (TS) is life threatening. In the mid-2000s, its incidence was poorly defined, peer-reviewed diagnostic criteria were not available, and management and treatment did not seem to be verified based upon evidence and latest advances in medicine. METHODS First, diagnostic criteria were developed based on 99 patients in the literature and seven patients in this study. Then, initial and follow-up surveys were conducted from 2004 through 2008, targeting all hospitals in Japan to obtain and verify information on patients who met diagnostic criteria for TS. Based on these data, the diagnostic criteria were revised, and management and treatment guidelines were created. RESULTS The incidence of TS in hospitalized patients in Japan was estimated to be 0.20 per 100,000 per year and 0.22% of all thyrotoxic patients. The mortality rate was 10.7%. Multiple organ failure was the most common cause of death, followed by congestive heart failure, respiratory failure, and arrhythmia. In the final diagnostic criteria for TS, the definition of jaundice as serum bilirubin concentration >3 mg/dL was added. Based upon nationwide surveys and the latest information, guidelines for the management and treatment for TS were extensively revised and algorithms were developed. CONCLUSIONS TS remains a life-threatening disorder, with >10% mortality in Japan. New peer-reviewed diagnostic criteria for TS are presented and its clinical features, prognosis, and incidence are clarified based on nationwide surveys. Furthermore, this information helped to establish detailed guidelines for the management and treatment of TS. A prospective prognostic study to validate the guidelines is eagerly anticipated.
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Affiliation(s)
- Takashi Akamizu
- The First Department of Medicine, Wakayama Medical University , Wakayama, Japan
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27
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Pangtey GS, Baruah U, Baruah MP, Bhagat S. Thyroid Emergencies: New Insight into Old Problems. J Assoc Physicians India 2017; 65:68-76. [PMID: 28799309] [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: 06/07/2023]
Abstract
Thyroid emergencies are major life-threatening endocrine conditions associated with life-threatening disorders resulting from either severe deficiency or excess of thyroid hormones. Deficiency of thyroid hormones may present as myxedema coma whereas excessive hormone production can present as life threatening thyrotoxic storm. The diagnosis of both requires a high index of clinical suspicion. Thyroid storm, in spite of accurate diagnosis, continues to have high fatality, whereas myxedema management has markedly improved with advancement in intensive care facility. The key to successful management of these emergencies is timely diagnosis and management by experienced physician in an intensive care setting. This article discusses the basic differences of both entities with an attempt to appropriate recognition and awareness of clinical signs and symptoms, highlight the salient diagnostic points and delineate the rational approach, which can lead to appropriate treatment at the earliest and reduce mortality.
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Affiliation(s)
| | - Udismita Baruah
- Senior Resident, Dept. of Anesthesia, VMMC & Safdurjung Hospital, New Delhi
| | - Manash P Baruah
- Senior Consultant, Excel Center (Excel Care Hospitals), Guwahati, Assam
| | - Sahil Bhagat
- Senior Resident, Dept. of Medicine, LHMC and Associated Hospitals, New Delhi
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29
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Schreiber ML. Thyroid Storm. Medsurg Nurs 2017; 26:143-145. [PMID: 30304599] [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: 06/08/2023]
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30
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Ikeoka T, Otsuka H, Fujita N, Masuda Y, Maeda S, Horie I, Ando T, Abiru N, Kawakami A. Thyroid Storm Precipitated by Diabetic Ketoacidosis and Influenza A: A Case Report and Literature Review. Intern Med 2017; 56:181-185. [PMID: 28090049 PMCID: PMC5337464 DOI: 10.2169/internalmedicine.56.7593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 46-year-old woman with a history of Graves' disease presented with the chief complaints of appetite loss, weight loss, fatigue, nausea, and sweating. She was diagnosed with diabetic ketoacidosis (DKA), thyroid storm, and influenza A. She was treated with an intravenous insulin drip, intravenous fluid therapy, intravenous hydrocortisone, oral potassium iodine, and oral methimazole. As methimazole-induced neutropenia was suspected, the patient underwent thyroidectomy. It is important to maintain awareness that thyroid storm and DKA can coexist. Furthermore, even patients who have relatively preserved insulin secretion can develop DKA if thyroid storm and infection develop simultaneously.
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Affiliation(s)
- Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
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31
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Baena JC, Padilla J, Guzmán G. [Thyroid storm associated with multiorganic dysfunction]. Medicina (B Aires) 2017; 77:337-340. [PMID: 28825582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Thyroid storm is a rare and potentially fatal condition. Unusual presentations in patients with thyroid storm have been described but multiorganic dysfunction is uncommonly seen. We describe the case of a 36-year-old woman with unknown underlying Graves's disease who developed thyroid storm. The thyroid storm score of Burch and Wartofsky was 50/140. This was complicated by acute liver failure, acute kidney injury, lactic acidosis, heart failure, bi-cytopenia, coagulopathy and rhabdomyolysis. The severe multiorgan dysfunction was reversed by prompt institution of steroids, cyclophosphamide and plasma exchange before thyroidectomy. Main difficulty lies in recognizing its varied presentations and offering appropriate treatment when physician faces either failure or contraindications of conventional therapy.
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Affiliation(s)
- Juan Camilo Baena
- Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | - Jacobo Padilla
- Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | - Guillermo Guzmán
- Servicio de Endocrinología, Fundación Valle del Lili, Cali, Colombia. E-mail:
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Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J 2016; 63:1025-1064. [PMID: 27746415 DOI: 10.1507/endocrj.ej16-0336] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [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: 11/23/2022] Open
Abstract
Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.
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Affiliation(s)
- Tetsurou Satoh
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
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Abstract
Hyperthyroidism is characterised by increased thyroid hormone synthesis and secretion from the thyroid gland, whereas thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source. The most common cause of hyperthyroidism is Graves' disease, followed by toxic nodular goitre. Other important causes of thyrotoxicosis include thyroiditis, iodine-induced and drug-induced thyroid dysfunction, and factitious ingestion of excess thyroid hormones. Treatment options for Graves' disease include antithyroid drugs, radioactive iodine therapy, and surgery, whereas antithyroid drugs are not generally used long term in toxic nodular goitre, because of the high relapse rate of thyrotoxicosis after discontinuation. β blockers are used in symptomatic thyrotoxicosis, and might be the only treatment needed for thyrotoxicosis not caused by excessive production and release of the thyroid hormones. Thyroid storm and hyperthyroidism in pregnancy and during the post-partum period are special circumstances that need careful assessment and treatment.
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Affiliation(s)
- Simone De Leo
- Endocrine Unit, Fondazione IRCCS Cà Granda, Milan, Italy (S De Leo MD); Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (S De Leo); and Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA (S De Leo, S Y Lee MD, Prof L E Braverman MD)
| | - Sun Y Lee
- Endocrine Unit, Fondazione IRCCS Cà Granda, Milan, Italy (S De Leo MD); Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (S De Leo); and Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA (S De Leo, S Y Lee MD, Prof L E Braverman MD)
| | - Lewis E Braverman
- Endocrine Unit, Fondazione IRCCS Cà Granda, Milan, Italy (S De Leo MD); Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (S De Leo); and Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA (S De Leo, S Y Lee MD, Prof L E Braverman MD)
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Krishna K, Pankaj M, Tuteja A, Jagtap V. Jaundice Heralding the Onset of Thyrotoxic Crisis. J Assoc Physicians India 2016; 64:94-95. [PMID: 27762123] [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: 06/06/2023]
Abstract
Thyrotoxic crisis is a life threatening medical condition that requires urgent diagnosis and treatment. Because of the wide variety of presenting symptoms, its diagnosis can be difficult in some cases and a high index of suspicion is required for diagnosis. We present a case of 53 year old patient who presented with fever, jaundice and passage of loose stools. Upon investigations other etiologies for hepatic injury were ruled out and she was found to be in thyrotoxic crisis causing liver injury.
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Affiliation(s)
| | | | | | - Varsha Jagtap
- Consultant Endocrinologist, Dept. of Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra
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Isozaki O, Satoh T, Wakino S, Suzuki A, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. Treatment and management of thyroid storm: analysis of the nationwide surveys: The taskforce committee of the Japan Thyroid Association and Japan Endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm. Clin Endocrinol (Oxf) 2016; 84:912-8. [PMID: 26387649 DOI: 10.1111/cen.12949] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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] [Received: 05/20/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thyroid storm (TS) is a life-threatening endocrine emergency. This study aimed to achieve a better understanding of the management of TS by analyzing therapeutic modalities and prognoses reported by nationwide surveys performed in Japan. DESIGN, PATIENTS AND MEASUREMENTS Retrospective analyses were performed on clinical parameters, outcomes, and treatments in 356 TS patients. RESULTS Patient disease severities assessed via Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores significantly correlated with mortality. Free triiodothyronine (FT3) and the FT3/free thyroxine (FT4) ratio inversely correlated with disease severity. Methimazole (MMI) was used in the majority of patients (78·1%), and there were no significant differences in mortality or disease severity between those treated with MMI and those receiving propylthiouracil (PTU). Patients who received inorganic iodide (KI) demonstrated higher disease severity but no change in mortality compared to those who did not. Patients treated with corticosteroids (CSs) demonstrated significantly higher disease severity and mortality than those who were not. Disease severity in patients treated with intravenous administration of beta-adrenergic antagonists (AAs) was significantly higher than those treated with oral preparations, although no significant difference in mortality was observed between these groups. In addition, mortality was significantly higher in patients treated with non-selective beta-AAs as compared with other types of beta-AAs. CONCLUSION In Japan, MMI was preferentially used in TS and showed no disadvantages compared to PTU. In severe TS, multimodal treatment, including administration of antithyroid drugs, KI, CSs and selective beta1 -AAs may be preferable to improve outcomes.
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Affiliation(s)
| | - Tetsurou Satoh
- Gunma University Graduate School of Medicine, Gunma, Japan
| | | | | | | | | | - Naotetsu Kanamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
- Osaka City General Hospital, Osaka, Japan
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Akamizu T. [Endocrine and Metabolic Emergencies; Points of Initial Management. Topics: III. Thyroid storm]. Nihon Naika Gakkai Zasshi 2016; 105:653-657. [PMID: 27491258 DOI: 10.2169/naika.105.653] [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: 06/06/2023]
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Ku BD, Park KC, Yoon SS. Fatal ischemic stroke in a case of progressive moyamoya vasculopathy associated with uncontrolled thyrotoxicosis. Korean J Intern Med 2015; 30:543-6. [PMID: 26161023 PMCID: PMC4497344 DOI: 10.3904/kjim.2015.30.4.543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 09/22/2008] [Accepted: 11/10/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bon D. Ku
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Key-Chung Park
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Sang Yoon
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
Neonatal thyroid storm is rare; the diagnostic criteria and management of neonatal thyroid storm have not been well established. In this paper, we report a preterm infant diagnosed with neonatal hyperthyroidism secondary to maternal Graves' disease who was discharged after therapy. Unfortunately, he was rehospitalised for neonatal thyroid storm. We will discuss the diagnosis and general therapy of neonatal thyroid storm.
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Shahid M, Mahar SA, Asghar A, Alam M. Thyroid storm associated with multinodular goiter: a difficult problem to treat. J Coll Physicians Surg Pak 2015; 25:225-226. [PMID: 25772969] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Muhammad Shahid
- Department of Endocrinology, Liaquat National Hospital, Karachi
| | | | - Ali Asghar
- Department of Endocrinology, Liaquat National Hospital, Karachi
| | - Maqsood Alam
- Department of Medicine, Liaquat National Hospital, Karachi
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Angell TE, Lechner MG, Nguyen CT, Salvato VL, Nicoloff JT, LoPresti JS. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab 2015; 100:451-9. [PMID: 25343237 DOI: 10.1210/jc.2014-2850] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 02/07/2023]
Abstract
CONTEXT Thyroid storm (TS) is a rare but life-threatening manifestation of thyrotoxicosis. Predictive features and outcomes remain incompletely understood, in part because studies comparing TS with hospitalized thyrotoxic patients have rarely been performed. OBJECTIVES Our objectives were to compare the diagnosis and outcomes in TS versus hospitalized compensated thyrotoxic (CT) patients and to assess differences in diagnostic classification using the Burch-Wartofsky scores (BWSs) or Akamizu (Ak) criteria for identifying TS. DESIGN, SETTING, AND PATIENTS This was a retrospective cohort study of hospitalized patients during a 6-year period at an academic tertiary hospital, with age ≥ 18 years, TSH <0.01 mIU/L, and clinically diagnosed TS or CT. OUTCOME MEASURES In-patient mortality, hospital and intensive care unit length of stay, intubation, and ventilator duration were assessed. RESULTS Twenty-five TS and 125 CT patients were identified and analyzed. All but 1 TS patient received thionamides, β-blockade, glucocorticoids, and iodides within 24 hours of diagnosis. CT patients received thionamides and β-blockade alone. In the acute hospital setting, rates of fever (>100.4 °F), heart rate (>100 beats/min), altered mentation, and a precipitating event were all higher for TS than for CT patients. Altered mentation was the only clinical feature significantly different between TS and the subset of CT patients defined as TS by BWS or Ak criteria (P < .001). TS patients had greater in-patient mortality, hospital and intensive care unit length of stay, and ventilation requirements than CT patients. CONCLUSIONS In acutely hospitalized thyrotoxic patients, the presence of central nervous system dysfunction distinguished clinically diagnosed TS from patients with BWS- or Ak-defined TS. Because TS patients had significantly worse outcomes in this study, thyrotoxic patients with possible TS and central nervous system dysfunction may derive the greatest benefit from aggressive supportive and TS-specific treatments.
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Affiliation(s)
- Trevor E Angell
- Division of Endocrinology and Diabetes (T.E.A., M.G.L., C.T.N., V.L.S., J.T.N., J.S.L.), USC Keck Medical Center, Los Angeles, California 90033; and Division of Endocrinology, Diabetes, and Hypertension (T.E.A., M.G.L.), Brigham and Women's Hospital, Boston, Massachusetts 02215
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Huang J, Lu Q, Yu JL. [Thyroid storm in a newborn infant]. Zhongguo Dang Dai Er Ke Za Zhi 2014; 16:659-660. [PMID: 24927448] [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: 06/03/2023]
Affiliation(s)
- Jing Huang
- Department of Neonatology, Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China
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Abstract
BACKGROUND Takotsubo or stress-induced cardiomyopathy is a form of reversible cardiomyopathy commonly associated with emotional or physical stress. Thyrotoxicosis has been identified as a rare cause of Takotsubo cardiomyopathy, with only 12 cases reported in the literature. Here, we report a case of thyroid storm presenting with Takotsubo cardiomyopathy in the setting of Graves' disease. PATIENT FINDINGS A 71-year-old woman presented with abdominal pain, vomiting, confusion, and history of weight loss. She was initially diagnosed and treated for diabetic ketoacidosis at another hospital and was transferred to our hospital one day after initial presentation because of concern for acute coronary syndrome. A diagnosis of Takotsubo cardiomyopathy was made on the basis of cardiac catheterization. At that time, she was diagnosed and treated for thyroid storm. Follow-up 7 weeks later revealed improvement of her cardiac function and near-normalization of thyroid hormone levels. SUMMARY In this patient, who presented with symptoms of heart failure, acute coronary syndrome was initially considered, but the diagnosis of Takotsubo cardiomyopathy associated with thyroid storm was ultimately made based on cardiac catheterization and laboratory investigation. CONCLUSIONS Thyrotoxicosis is associated with adverse disturbances in the cardiovascular system. Takotsubo cardiomyopathy could be a presenting manifestation of thyroid storm, perhaps related to excess catecholamine levels or sensitivity.
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Affiliation(s)
- Myrto Eliades
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Diala El-Maouche
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chitra Choudhary
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Bruce Zinsmeister
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D. Burman
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
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Kumar S, Moorthy N, Yadav S, Kapoor A, Dale DC. Authors' reply. J Postgrad Med 2013; 59:340-341. [PMID: 24490312] [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: 06/03/2023] Open
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Abstract
Agranulocytosis is a rare yet life-threatening complication of methimazole therapy for hyperthyroidism. We present the case of a 37-year-old female recently started on methimazole for hyperthyroidism who presented to our facility for evaluation of suspected thyroid storm. In addition to having abnormal thyroid indices, she was noted to have an odontogenic abscess, and was septic with profound neutropenia. Her symptoms resolved quickly following incision and drainage of her abscess and treatment with broad-spectrum antibiotics. Her neutrophil count improved significantly following cessation of methimazole and administration of granulocyte colony-stimulating factor. Diagnosis was initially confounded by the similarity between symptoms of early sepsis and those of thyroid storm. This case report discusses the factors leading to diagnostic delay and highlights the dangerous manifestations of neutropenia in patients on methimazole therapy.
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Affiliation(s)
- Samuel G Rayner
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Akamizu T. [Diagnosis and treatment of thyroid storm]. Nihon Rinsho 2012; 70:2000-2004. [PMID: 23214075] [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: 06/01/2023]
Abstract
Thyrotoxic storm is a life-threatening condition requiring emergency treatment. Neither its epidemiological data nor diagnostic criteria have been fully established. We clarified the clinical and epidemiological characteristics of thyroid storm using nationwide surveys and then formulate diagnostic criteria for thyroid storm. To perform the nationwide survey on thyroid storm, we first developed tentative diagnostic criteria for thyroid storm, mainly based upon the literature (the first edition). We analyzed the relationship of the major features of thyroid storm to mortality and to certain other features. Finally, based upon the findings of these surveys, we revised the diagnostic criteria. Thyrotoxic storm is still a life-threatening disorder with over 10% mortality in Japan.
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Kiran HS, Ravikumar YS, Thippeswamy T, Kirushnan BB. Thyrotoxicosis induced liver disease: a case report. J Indian Med Assoc 2012; 110:576-577. [PMID: 23741826] [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: 06/02/2023]
Abstract
Thyroid storm is a severe variety of thyrotoxicosis. It is an uncommon condition but can be fatal. Mildly raised serum bilirubin levels can be seen in up to 5% of patients with thyrotoxicosis, butmarked elevations are rare. The association of severe thyrotoxicosis with severe hepatic dysfunction hasbeen rarely reported. Here an interesting case of thyrotoxicosis induced liver disease which improved following aggressive treatment is reported.
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Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Monden T, Kouki T, Otani H, Teramukai S, Uehara R, Nakamura Y, Nagai M, Mori M. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid 2012; 22:661-79. [PMID: 22690898 PMCID: PMC3387770 DOI: 10.1089/thy.2011.0334] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [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: 12/27/2022]
Abstract
BACKGROUND Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. METHODS We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. RESULTS We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration >3 mg/dL. CONCLUSIONS TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications.
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Affiliation(s)
- Takashi Akamizu
- The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
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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.
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Affiliation(s)
- Atul Vijay Palkar
- Department of Internal Medicine, St Vincent Hospital, Worcester, Massachusetts, USA
| | | | - Nivedita D Moulick
- Department of Internal Medicine, Lokmanya Tilak Municipal Medical College & Hospital, Mumbai, India
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