Abstract
Thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1% to 2%. It is a systemic condition of excessive thyroid hormone production and release leading to thermoregulatory, adrenergic, neuropsychiatric, cardiovascular, and abdominal manifestations. Although it is a rare condition, it carries a significant mortality rate. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment. In this article, we present an unusual case of a young woman who presented with psychosis as the manifesting symptom of thyroid storm. She did not respond adequately to conventional medical treatment, requiring plasmapheresis and a definitive thyroidectomy, which ultimately led to the return of patient’s baseline mental status and a dramatic recovery.
Highlights
A 28-year-old Hispanic female with a past medical history of migraine, depression, and a family history of schizophrenia was brought to the emergency room by her family as she was not acting her usual self and was demonstrating strange behavior for 1 week prior to admission
In view of worsening thyroid function tests and worsening psychosis despite 10 days of treatment, and due to the concern for an impending decompensation due to thyroid storm, a decision was made to proceed with plasmapheresis in preparation for an urgent thyroidectomy
She received 2 rounds of plasmapheresis, which resulted in normalization of thyroid hormone levels followed by total thyroidectomy
Summary
A 28-year-old Hispanic female with a past medical history of migraine, depression, and a family history of schizophrenia was brought to the emergency room by her family as she was not acting her usual self and was demonstrating strange behavior for 1 week prior to admission. Vital signs at the time of admission showed temperature of 99.6°F, heart rate of 144 beats per minute, and elevated blood pressure of 160/72 mm Hg. Physical examination was notable for an enlarged and smooth thyroid gland with an audible bruit. Urine toxicology screen, computed tomography scan of the head, and infectious workup were negative Given her altered mental status (20 points), tachycardia (25 points), abdominal symptoms (10 points), and fever (5 points), a diagnosis of thyroid storm was made, with a Burch and Wartofsky score of 60 (Table 2). Treatment for thyroid storm was immediately started including propranolol 60 mg 3 times daily, methimazole 20 mg twice daily, and saturated solution of potassium iodide 5 drops every 6 hours, given an hour after first dose of methimazole.
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