A Patient with Thyroid Storm Presenting with Apathetic Thyrotoxicosis and Features of Meningoencephalitis

Abstract

Apathetic thyrotoxicosis is distinctly unusual in thyroid storm and features of meningoencephalitis are very rare. Here we present such a patient. The patient was a 67-year-old Chinese woman who presented with acute generalized weakness, decreased mentation, fever, and rapid deterioration to coma, accompanied by meningism, initially mimicking meningoencephalitis. Further investigations excluded intracranial lesions. Laboratory findings were consistent with Graves' thyrotoxicosis. She was treated for thyroid storm with antithyroid drugs, Lugol's iodine solution, and other supportive management. Subsequently, her level of consciousness returned to normal and neurological signs resolved. We report a patient with thyroid storm with an apathetic presentation, manifesting as coma with meningism, that mimicked meningoencephalitis. These resolved after treatment for thyroid storm was instituted. Apathetic thyrotoxicosis is a rare presentation of thyroid storm. Early recognition and treatment is essential for reducing its morbidity and mortality.