Tormenta tiroidea asociada a disfunción multiorgánica / Thyroid storm associated with multiorganic dysfunction

La tormenta tiroidea es una condición infrecuente y potencialmente fatal. En la literatura han sido descritas varias presentaciones inusuales de la misma; sin embargo, la disfunción multiorgánica es rara vez vista. Aquí describimos un caso en una mujer de 36 años de edad con enfermedad de Graves subyacente no diagnosticada hasta entonces, quien inició su sintomatología con una tormenta tiroidea. Su score de Burch y Wartofsky fue de 50/140. Desarrolló falla hepática aguda, falla renal aguda, acidosis láctica, falla cardíaca, bicitopenia, coagulopatía y rabdomiolisis. La disfunción multiorgánica se revirtió gracias a la pronta instauración de los esteroides, ciclofosfamida, plasmaféresis y posterior tiroidectomía. La dificultad reside en reconocer las variadas presentaciones de la enfermedad y ofrecer un tratamiento apropiado cuando se enfrenta a las contraindicaciones o las fallas terapéuticas del tratamiento convencional.

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.

Fatal ischemic stroke in a case of progressive moyamoya vasculopathy associated with uncontrolled thyrotoxicosis

No abstract available.

Ruptura de cordoalha mitral associada a crise tireotóxica: uma avaliação por ecocardiograma 3D / Mitral chordae rupture associated with thyrotoxic crisis: an assessment by 3D echocardiography

Relatamos o caso de ruptura de cordoalha mitral em um paciente adulto jovem, com apresentação clínica de febre, novo sopro cardíaco e disfunção respiratória, condição em que a hipótese de endocardite infecciosa é mandatória. Entretanto, o curso clínico, com ausência de critérios maiores para endocardite, a presença concomitante de crise tireotóxica e uma válvula mitral sem outras alterações estrututurais ecocardiográficas, reforça a hipótese alternativa de rutura de cordoalha associada ao estado hiperdinânimo. Os achados foram apropriadamente documentados e confirmados por ecocardiograma 3D. A revisão da literatura existente descreve que, embora a presença de regurgitação mitral leve a moderada seja altamente prevalente na tireotoxicose, a ruptura mitral na ausência de outras anormalidades estruturais é um achado raro e inesperado.

We report a case of a mitral chordaea rupture in a young adult patient presenting with fever, new cardiac murmur and respiratory distress, where the hypothesis of infective endocarditis was primarily selected as the main clinical concern. However, the clinical course in the absence of major criteria for endocarditis, the concomitant presence of a thyrotoxic state and no other echocardiographic detected structural alterations, strengthened the alternative hypothesis of primary rupture due to the hyperkinetic state. These findings were thoroughly documented and confirmed by 3D-echocardiography. The literature review describes that, although mild to moderate mitral regurgitation is highly prevalent in thyrotoxicosis, mitral rupture, in the absence of a previous structural abnormality, is a rare unexpected finding.

Tormenta tiroidea intraoperatoria. Experiencia única: presentación de caso / Thyroid storm during operation. The only one experience. A case report

Introducción: La tormenta tiroidea es la complicación más alarmante del hipertiroidismo. Objetivo: describir la conducta perioperatoria y evolución de una paciente con diagnóstico de bocio hipertiroideo, la cual presentó un cuadro de tormenta tiroidea intraoperatoria, experiencia única en nuestro servicio. Presentación del caso: Paciente femenina de 30 años de edad con diagnóstico de bocio hipertiroideo anunciada de forma electiva para cirugía del tiroides. Presentó un cuadro de hiperpirexia marcada, sudación excesiva, taquicardia que alcanzó valores de 160 latidos por minuto durante la cirugía. Se interpretó el cuadro como una tormenta tiroidea, se comenzaron las medidas terapéuticas de inmediato con betabloqueadores, antitiroideos y medidas antitérmicas. La paciente mostró reversión de los signos que permitió realizar tiroidectomía total, sin complicaciones postoperatorias y se trasladó a la sala de cuidados intensivos en la que permaneció durante 72 horas. Conclusiones: La tormenta tiroidea es una condición infrecuente pero potencialmente grave, su diagnóstico y tratamiento deben ser inmediatos y enérgicos para lograr resultados satisfactorios.

Introduction: The thyroid storm is the most alarming complication of hyperthyroidism. Objective: To describe the perioperative management and evolution of a patient with diagnosis of Hyperthyroid goiter who presented a thyroid storm during operation, the only one experience in our service. Case report: It was a 30 years old patient, female, with hyperthyroid goiter diagnosis announced in an elective form for thyroid surgery. She had high fever, excessive sweating and tachycardia of 160 beats per minute during the surgery. The patient had a thyroid storm and began the treatment immediately with beta-blockers, antithyroid medications and correction of the fever. The patient evidenced signs reversion and a total thyroidectomy was achieved without postoperative complications and she was transferred to the intensive care unit where she stayed for 72 hours. Conclusions: The thyroid storm is an infrequent condition but potentially grave, its diagnosis and treatment must be immediate and energetic to achieve satisfactory outcomes.

Doença de basedow graves associada à acidose tubular renal e paralisia periódica tireotóxica: relato de um caso e revisäo da literatura / Graves' basedow disease associated acidosis renal tubular and thyrotoxic periodic paralysis: report of a case and review of the literature

Doenças tireoidianas autoimunes (DTA) tem sido associadas esporadicamente à acidose tubular renal tipo 1 (ART-1). Apresentamos o segundo caso descrito na literatura, de nosso conhecimento, de doenças de Basedow-Graves associada à ATR e à paralisia periódica tiretóxica (PPT). Os níveis de pH sanguíneo e de eletrólitos nao se normalizaram com a correçao da disfunçao tireodiana. A paralisia revertou com a administraçao de grandes quantidades de potássio (300-445 mEq/dia) e a acidose com ingestao de bicarbonato (15g/24h). Nefrocalcinose bilateral estava presente com hipercalciúria (310-603 mg/24 h) e diabetes insípidus nefrogênico (Osmolaridade urinárias= 347 mOsm após DDAVP). Aventa-se um mecanismo autoimune na gênese da ATR-1à semelhança do que ocorre na doença tireodiana associada. (Arq Bras Endocrinol Metab 1994; 38/1:35-38).