Apathetic hyperthyroidism presenting as shock and complete heart block

Apathetic thyrotoxicosis is an exceedingly rare presentation of thyroid storm. The clinical picture is one of apathy rather than hyperactivity, and cardiovascular manifestations predominate though abnormal atrioventricular [AV] conduction specially complete heart block are very rare. We report a case of a 28 year-old Indian staff nurse presenting with loss of consciousness, shock and complete heart block which promptly resolved after the thyrotoxicosis was treated by oral carbimazole and few doses of hydrocortisone