Abstract
A 38-year-old gentleman presented with thyroid storm with multiorgan involvement in the form of heart failure (thyrotoxic cardiomyopathy), respiratory failure (respiratory muscle fatigue), hepatic dysfunction, fast atrial fibrillation, pulmonary embolism, and disseminated intravascular coagulation (DIC). His Graves' disease (GD) remained undiagnosed for nearly 8 months because apart from weight loss, he has not had any other symptoms of thyrotoxicosis. The presentation of thyroid storm was atypical (apathetic thyroid storm) with features of depression and extreme lethargy without any fever, anxiety, agitation, or seizure. There were no identifiable triggers for the thyroid storm. Apart from mechanical ventilation and continuous veno-venous renal replacement therapy in the intensive care unit, he received propylthiouracil (PTU), esmolol, and corticosteroids, which were later switched to carbimazole and propranolol with steroids being tapered down. He was diagnosed with thyrotoxic myopathy which, like GD, remained undiagnosed for long (fatigability). A high index of suspicion and a multidisciplinary care are essential for good outcome in these patients.
Highlights
A 38-year-old gentleman presented with thyroid storm with multiorgan involvement in the form of heart failure, respiratory failure, hepatic dysfunction, fast atrial fibrillation, pulmonary embolism, and disseminated intravascular coagulation (DIC)
His Graves’ disease (GD) remained undiagnosed for nearly 8 months because apart from weight loss, he has not had any other symptoms of thyrotoxicosis. e presentation of thyroid storm was atypical with features of depression and extreme lethargy without any fever, anxiety, agitation, or seizure. ere were no identifiable triggers for the thyroid storm
100,000 patients [1]. yroid storm is associated with 12-fold higher hospital mortality compared to thyrotoxicosis without storm (1.2–3.6% vs. 0.1–0.4%), longer hospital stays (4.8–5.6 vs. 2.7–3.4 mean days), and increased treatment costs [1]
Summary
A 38-year-old gentleman presented to the emergency department (ED) with worsening shortness of breath, chest tightness, and dry cough of 3-day duration Apart from these symptoms, he has been experiencing frequent watery diarrhoea for 2 weeks associated with intermittent vomiting, fatigue, extreme lethargy, and a depressed mood. He has had a weight loss of nearly 6-7 kg over 8 months, which the patient considered as intentional. Ere was no history of fever, palpitation, abdominal pain, haematemesis, malaena, jaundice, loss of appetite, agitation, confusion, or seizure. Cardiorespiratory examination showed grossly congested neck veins, with bibasal crackles His Glasgow Coma Scale (GCS) was 15/ 15, and there was no focal neurological deficit. Genital examination showed penile cellulitis which has been an ongoing problem for last few weeks
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
