ABSTRACT
Thyroid storm is a rare and potentially fatal disease characterized by severe clinical manifestations of thyrotoxicosis. The most common cause of hyperthyroidism is Graves's disease (GD) and infections are the most important precipitating factor. A woman of 33 years with history of hyperthyroidism, hypertension and morbid obesity. She was treated with propylthiouracil for one year, and then suspended controls and treatment 2 years ago. Consult for 2 weeks characterized by dyspnea, cough and expectoration, plus an episode of generalized tonic-clonic seizure. In postictal state, persists with dyspnea and chest pain, which is brought to the emergency room. It is hypotensive, with fever and tachycardia, SatO2 60% on room air. It is intubated and connected to invasive mechanical ventilation. It evolves with monomorphic ventricular tachycardia, requiring cardioversion twice, recovering sinus rhythm. Imaging studies reported bilateral lung disease. CT scan brain and lumbar punture are normal. As is treated as septic shock lung focus. Among its tests: TSH 0.01 mIU/L, T4 T 23.9 ug/dL, T4L 4.77 ng/dL, T3 5.38 ng/ml, with Wartofsky Score: 90. It is managed as TS, treatment is initiated with methimazole, Propranolol, Hydrocortisone. Thyroid ultrasound shows: Goiter with cold nodules. In addition has positive TRAb. She recovers both of system cardiovascular and their respiratory infection. The patient is prepared with amiodarone and lugol for total thyroidectomy. Concordant biopsy with GD.
Subject(s)
Humans , Female , Adult , Thyroid Crisis/diagnosis , Thyroid Crisis/etiology , Thyroid Crisis/therapy , Graves Disease/complications , ThyrotoxicosisABSTRACT
A thyroid storm is a life-threatening exacerbation of thyrotoxicosis, and is usually characterized by hyperthermia, tachycardia, severe agitation and altered mental status. A thyroid storm may be triggered by many causes, including systemic pulmonary infections. Delay in prompt diagnosis leads to high mortality. We present the first case of H1N1 infection triggering a thyroid storm. The delay in diagnosis because of preoccupancy with the H1N1 pandemic may have contributed to the poor outcome. When assessing cases with H1N1 infection, physicians should be more vigilant in order not to miss other important diagnoses
Subject(s)
Humans , Female , Influenza A Virus, H1N1 Subtype , Thyroid Crisis/etiology , /diagnosisABSTRACT
We describe a case of thyroid storm due to thyrotoxicosis factitia, which was caused by the ingestion of excessive quantities of exogenous thyroid hormone for the purpose of reducing weight. An 18-year-old female was admitted to the hospital 24 hours after taking up to 50 tablets of synthyroid (1 tablet of synthyroid : levothyroxine 100 microgram). Because of her stuporous mental state and acute respiratory failure, she was intubated and treated in the intensive care unit. After reviewing her history carefully and examining plasma thyroid hormone levels, we diagnosed this case as a thyroid storm due to thyrotoxicosis factitia. Her thyroid function test revealed that T3 was 305 ng/dL, T4 was 24.9 microgram/dl, FT4 was 7.7 ng/dL, TSH was 0.05 micro IU/mL and TBG was 12.84 microgram/mL (normal range: 11.3 - 28.9). TSH receptor antibody, antimicrosomal antibody, and antithyroglobulin antibody were negative. She was recovered by treatment, namely, steroid and propranolol, and was discharged 8 days after admission. Thyroid storm due to thyrotoxicosis factitia caused by the ingestion of excessive thyroid hormone is rarely reported worldwide. Therefore, we now report a case of thyroid storm that resulted from thyrotoxicosis factitia caused by the ingestion of a massive amount of thyroid hormone over a period of 6 months.