Abstract
Thyroid storm is a rare and a life-threatening condition, and serious complications could happen if not diagnosed and managed early. The typical clinical manifestations of hyperthyroidism are exaggerated in thyroid storm, particularly marked pyrexia and tachycardia, and altered mental status as agitation, delirium, or coma. Many precipitating factors contribute to the presentation of thyroid storm, and new recent factors like Epstein-Barr virus (EBV) could play a significant role. Serious and rare complications from the thyroid storm can increase the risk of mortality and morbidity up to 30% as fulminant hepatic failure, which is reported only a handful of times in the literature. Also, congestive heart failure can be part of the multiorgan dysfunction from the presentation, if associated with the thyroid storm.In this report, we present a case of thyroid storm precipitated by EBV and causing fast atrial fibrillation complicated by congestive heart failure and fulminant hepatic failure for 46-year-old Bangladeshi male not known to have any medical illness. He presented to the emergency department with 10-day history of an on and off subjective fever, associated with generalized abdominal pain and vomiting. He developed palpitation at the day of presentation. He was managed, stabilized, intubated, and shifted to the ICU as the patient started to be apneic after the conscious sedation for the cardioversion. During the admission anti-EBV viral capsid antigen IgM antibody was positive. The patient was discharged after five days in ICU and 14 days of overall hospital stay.Although the complication of thyroid storm as fulminant hepatic failure and congestive heart failure are rare, they should be considered in cases with thyroid storm. The pre-existing of EBV as a precipitating factor should always be considered, and more studies in these regards need to be done.
Highlights
Thyroid emergencies are not common; they are very serious life-threatening conditions
We present a case of thyroid storm precipitated by Epstein-Barr virus (EBV) and causing fast atrial fibrillation complicated by congestive heart failure and fulminant hepatic failure for 46-year-old Bangladeshi male not known to have any medical illness
At the end of this report, we can conclude that Fulminant hepatic failure (FHF) is a rare complication of the thyroid storm, we should consider it more as it might lead to a higher rate of mortality if not managed early
Summary
Thyroid emergencies are not common; they are very serious life-threatening conditions. He returned to normal mental status, but he was still tachycardic, and his rhythm showed fast atrial fibrillation He started to be hypoxic, so he was placed on bilevel positive airway pressure (BiPAP). Thyroid storm was confirmed by BWPS (Burch-Wartofsky Point Scale) (Table 2), which was 65 points (25 as tachycardia more than 140, 10 points for the presence of atrial fibrillation, 20 as severe congestive heart failure, and 10 points as for vomiting and abdominal pain) [4]. Criteria Thermoregulatory dysfunction Temperature (°C) 37.2-37.7 37.8-38.3 38.4-38.8 38.9-39.4 39.5-39.9 More than 40.0 Cardiovascular Tachycardia (beats per minute) 100-109 110-119 120-129 130-139 140 and above Atrial fibrillation Absent Present Congestive heart failure Absent Mild Moderate Severe Gastrointestinal-hepatic dysfunction Absent Moderate (diarrhea, abdominal pain, nausea/vomiting) Severe (jaundice) Central nervous system disturbance Absent Mild (Agitation). After one-month follow-up, the patient's symptoms improved, and the last TSH level tested was within the normal range (3.0 uLU/mL)
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