Thyroid storm: a case of haemodynamic failure promptly reversed by aggressive medical therapy with antithyroid agents and steroid pulse

BMJ Case Rep. 2018 Dec 14;11(1):e226669. doi: 10.1136/bcr-2018-226669.

Abstract

Hyperthyroidism is a common metabolic disorder, although its presentation as an endocrine emergency called thyroid storm is rare. Here we review a case of a thyroid storm as the initial presentation of thyrotoxicosis, with multiple organ failure and haemodynamic collapse due to low-output cardiac dysfunction. Quick intervention with aggressive antithyroid therapy, including steroid pulse, and supportive intensive care measures led to an outstanding improvement and full recovery. The present case clearly shows the beneficial impact of initial clinical suspicion resulting in an early diagnosis and intensive therapy. Moreover, it supports the additional role of steroids to aggressive antithyroid strategy in order to control associated deleterious systemic inflammatory reactions.

Keywords: drugs: endocrine system; emergency medicine; medical education; therapeutic indications; thyroid disease.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anticholesteremic Agents / therapeutic use
  • Antithyroid Agents / therapeutic use*
  • Cholestyramine Resin / therapeutic use
  • Critical Care* / methods
  • Heart Rate
  • Hemodynamics
  • Humans
  • Iodides / therapeutic use
  • Male
  • Middle Aged
  • Multiple Organ Failure / drug therapy*
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / physiopathology
  • Propylthiouracil / therapeutic use
  • Shock, Cardiogenic / drug therapy*
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / physiopathology
  • Steroids / therapeutic use*
  • Thyroid Crisis / complications
  • Thyroid Crisis / drug therapy*
  • Thyroid Crisis / physiopathology
  • Treatment Outcome
  • Ventricular Dysfunction, Left / drug therapy*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology
  • Weight Loss

Substances

  • Anticholesteremic Agents
  • Antithyroid Agents
  • Iodides
  • Steroids
  • Cholestyramine Resin
  • Propylthiouracil
  • Lugol's solution