Thyroid Storm Research Articles

Untreated Graves’ Disease Complicated by Thyroid Storm and High-Output Cardiac Failure: A Case Report

Untreated Graves’ Disease Complicated by Thyroid Storm and High-Output Cardiac Failure: A Case Report

Thyrotoxic Cardiomyopathy: A Rare Case of Thyroid Storm Presenting as De Novo Heart Failure

Thyrotoxic Cardiomyopathy: A Rare Case of Thyroid Storm Presenting as De Novo Heart Failure

Plasmapheresis in thyrotoxicosis: a single-center case series

BackgroundPlasmapheresis represent an alternative therapeutic option for hyperthyroidism with thyroid storm or refractory cases. It provides a rapid decrease in plasma thyroid hormones and anti-thyroid antibodies. The aim of this paper was to report our single center’s experience in managing particular situations of hyperthyroidism using apheresis.Cases presentationThe following case series describes three young African patients (two females, one male) aged 29, 37, and 25 years old, respectively, with Graves’ disease who presented with drug ineffectiveness, drug-induced agranulocytosis, and thyroid storm with multi-organ failure. The three patients underwent plasmapheresis sessions leading to effective decline of thyroid hormone levels and offering a window for processing total thyroidectomy.Discussion/conclusionThe standard management of thyrotoxicosis and thyroid storm was usually codified by the concomitant use of antithyroid medication, iodine, beta-blockers, and corticosteroids. This medical preparation can be effective in most cases. However, drug toxicity or ineffectiveness can limit the use of such therapeutics. Our paper supports the efficiency and safety of therapeutic plasma exchange in the preoperative management of thyrotoxicosis.

Clinical Efficacy of Beta-1 Selective Beta-Blockers Versus Propranolol in Patients With Thyroid Storm: A Retrospective Cohort Study.

Thyroid storm is the most severe manifestation of thyrotoxicosis. Beta-blockers are among the standard treatment regimens for this condition, with propranolol being the historically preferred option. However, 2016 guidelines issued by the Japan Thyroid Association and the Japan Endocrine Society recommend the use of beta-1 selective beta-blockers over nonselective beta-blockers, such as propranolol. Nevertheless, evidence supporting this recommendation is limited. Herein, we aimed to investigate the in-hospital mortality of patients with thyroid storms based on the choice of beta-blockers. Retrospective cohort study. The Diagnosis Procedure Combination database, a national inpatient database in Japan. Patients hospitalized with thyroid storm between April 2010 and March 2022. Propensity-score overlap weighting was performed to compare in-hospital mortality between patients who received beta-1 selective beta-blockers and those who received propranolol. Subgroup analysis was also conducted, considering the presence or absence of acute heart failure. Among the 2462 eligible patients, 1452 received beta-1 selective beta-blockers and 1010 received propranolol. The crude in-hospital mortality rates were 9.3% for the beta-1 selective beta-blocker group and 6.2% for the propranolol group. After adjusting for baseline variables, the use of beta-1 selective beta-blockers was not associated with lower in-hospital mortality (6.3% vs. 7.4%; odds ratio, 0.85; 95% CI, 0.57-1.26). Furthermore, no significant difference in in-hospital mortality was observed in patients with acute heart failure. In patients with thyroid storm, the choice between beta-1 selective beta-blockers and propranolol did not affect in-hospital mortality, regardless of the presence of acute heart failure. Therefore, both beta-1 selective beta-blockers and propranolol can be regarded as viable treatment options for beta-blocker therapy in cases of thyroid storm, contingent upon the clinical context.

Potassium Iodide Use and Patient Outcomes for Thyroid Storm: An Observational Study.

Iodine, combined with antithyroid drugs, is recommended as an initial pharmacologic treatment for thyroid storm according to some clinical guidelines. However, the clinical efficacy of iodine in managing thyroid storm remains unexplored. This study aimed to determine whether early potassium iodide (KI) use is associated with mortality in patients hospitalized for thyroid storm. Using the Japanese Diagnosis Procedure Combination database, we identified patients hospitalized with thyroid storm between July 2010 and March 2022. We compared in-hospital mortality, length of stay, and total hospitalization costs between patients who received KI within two days of admission (KI group) versus those who did not (non-KI group). Prespecified subgroup analyses were performed based on the presence of the diagnosis of Graves' disease. Among 3,188 eligible patients, 2,350 received KI within two days of admission. The crude in-hospital mortality was 6.1% (143/2,350) in the KI group and 7.8% (65/838) in the non-KI group. After adjusting for potential confounders, KI use was not significantly associated with in-hospital mortality (odds ratio [OR] for KI use, 0.91; 95% confidence interval [CI], 0.62-1.34). In patients with the diagnosis of Graves' disease, in-hospital mortality was lower in the KI group than in the non-KI group (OR, 0.46; 95% CI, 0.25-0.88). No significant difference in in-hospital mortality was observed in patients without the diagnosis of Graves' disease (OR, 1.11; 95% CI, 0.67-1.85). Length of stay was shorter (subdistribution hazard ratio, 1.15; 95% CI, 1.05-1.27), and total hospitalization costs were lower (OR, 0.92; 95% CI, 0.85-1.00) in the KI group compared with the non-KI group. Our findings suggest that KI may reduce in-hospital mortality among patients hospitalized for thyroid storm with Graves' disease.

Prospective Multicenter Registry-Based Study on Thyroid Storm: The Guidelines for the Management from Japan are Useful.

The mortality rate in thyroid storm (TS) has been reported to be higher than 10%. We aimed to evaluate the effectiveness of the 2016 guidelines for the management of TS proposed by the Japan Thyroid Association and Japan Endocrine Society. Prospective registry-based study through a secure web platform. Prospective multicenter registry. Patients with new-onset TS were registered in the Research Electronic Data Capture (REDCap). On day 30 after admission, clinical information and prognosis of each patient were added to the platform. On day 180, the prognosis was described. This study included 110 patients with TS. The median of Acute Physiology and Chronic Health Evaluation (APACHE) II score was 13, higher than the score in the previous nationwide epidemiological study, 10 (p = 0.001). Nonetheless, the mortality rate at day 30 was 5.5%, approximately half compared with 10.7% in the previous nationwide survey. Lower body mass index, shock and lower left ventricular ejection fraction were positively associated with poor prognosis at day 30, while the lack of fever ≥ 38℃ was related to the outcome. The mortality rate in patients with an APACHE II score ≥12 for whom the guidelines were not followed was significantly higher than the rate in patients for whom the guidelines were followed (50% vs. 4.7%) (p = 0.01). Prognosis seemed better than in the previous nationwide survey, even though disease severity was higher. The mortality rate was lower when the guidelines were followed. Thus, the guidelines are useful for managing TS.

STEMI and Thyroid Storm: A Case Report of Thyrotoxicosis-Induced Cardiomyopathy

Thyrotoxicosis-induced cardiomyopathy is a rare but potentially fatal form of non-ischemic cardiomyopathy that warrants immediate medical intervention. A 51-year-old female with no known disease sought consultation because of severe chest pain accompanied by easy fatigability and palpitation. Upon arrival at the ED, there was persistence of chest pain accompanied by vomiting, tachycardia and hypotension. ECG showed STEMI in the lead aVR, and she eventually underwent coronary angiogram, which revealed normal coronary arteries. Ancillaries showed severe hyperthyroidism with a Burch – Wartofsky score of 50. There was an elevated NT-proBNP level, and echocardiogram showed a reduced EF of 28.7% with dilated LV and global hypokinesia. She was hooked to a norepinephrine and dobutamine drip and immediately initiated a hyperthyroid regimen, specifically methimazole, propranolol, and steroids. She was admitted to the critical care unit where initiation of SGLT-2 inhibitor and spironolactone were administered as part of the heart failure regimen. When she was out of thyroid storm, a sestamibi myocardial perfusion scan was requested, which showed normal results with improved EF. The goals of management in thyrotoxicosis-induced cardiomyopathy are early initiation of heart failure regimen, medication to prevent further ventricular remodeling, and treatment of thyroid storm. Early recognition and prompt administration of hyperthyroid treatment leads to a decreased burden of the patient’s disease and a good overall prognosis.

198 - Ballistic injury to neck causing possible thyroid storm

198 - Ballistic injury to neck causing possible thyroid storm

LAPORAN KASUS HIPERTIROIDISME PADA KEHAMILAN: HASIL IBU DAN NEONATAL

Normal pregnancy induces some clinical findings similar to thyroxine excess; Clinically mild thyrotoxicosis may be difficult to diagnose. Hyperthyroidism in pregnancy is a hyperthyroid condition that existed before pregnancy, or a condition that was acquired during pregnancy. The aim of this study is to determine the management of hyperthyroidism in uncontrolled hyperthyroid pregnancies and the clinical outcomes for mothers and neonates. The location of the research was Arifin Achmad Rekanbaru Regional Hospital. The research method is a study that explores a problem in detail, and collects in-depth data and includes various sources of information that will help doctors gain insight into hyperthyroidism in pregnancy. Data was taken retrospectively from medical records, from February to April 2021. The results of the study were that the management of hyperthyroidism in the first and second patients was the same, but the maternal and neonatal outcomes obtained were different. In both cases, both experienced uncontrolled hyperthyroidism. The neonatal outcome of the first patient was poor, but the mother survived. Unlike the second patient who died of thyroid storm, the baby was saved. Treatment should be carried out in intensive care areas that include special care units during labor and delivery units. Patients with uncontrolled hyperthyroidism are in the high risk group and require early fetal surveillance examination. Treatment with propylthiouracil, a thionamide that inhibits thyroid biosynthesis and peripheral conversion of T4 to T3 has become the drug of choice for hyperthyroidism in pregnancy. Proper management of hyperthyroidism during pregnancy is very important for the mother and fetus. Untreated hyperthyroidism can lead to pregnancy-related complications such as premature birth, growth restriction, and even fetal death.

Complications related to thyroidectomy among patients with hyperthyroidism: Exploring the potential for ambulatory surgery.

Total thyroidectomy for hyperthyroidism is typically followed by overnight admission to monitor for complications including thyrotoxicosis. Outpatient thyroid surgery is increasingly common, but its safety in patients with hyperthyroidism has not been well studied. This retrospective study reviewed 183 patients with hyperthyroidism who underwent total thyroidectomy from 2015 to 2022 at one urban, academic center. The main outcomes were rates of thyroid storm, surgical complications, and 30-day ED visits and readmissions. Among 183 patients with hyperthyroidism (mean age, 45 ± 14.5 years; 82.5% female), there were no cases of thyroid storm and complications included recurrent laryngeal nerve (RLN) palsy (7.0%), symptomatic hypocalcemia (4.4%), and hematoma (1.6%). ED visits were present in 1.1% and no patients were readmitted. Total thyroidectomy was not associated with thyroid storm and <6% of patients required inpatient management. Ambulatory total thyroidectomy for hyperthyroidism warrants further consideration through identification of predictive factors for postoperative complications.

Case Report: Pediatric Thyroid Storm Presenting to the Emergency Department with Afebrile Seizure.

Seizures are a common presenting complaint and account for approximately 1% of total emergency department (ED) visits. Seizures are especially common in children less than fiveyears old as they have a lower seizure threshold as compared to adults. One potentially dangerous etiology that is far less common, especially in children, is thyroid storm, the extreme manifestation of hyperthyroidism. We describe the case of a 3-year-old girl who presented to the ED with an afebrile seizure but was found to be in thyroid storm. This case should serve as a reminder for emergency physicians to consider thyroid disease when evaluating patients presenting with seizures. Although most pediatric seizures are self-limited and frequently benign, it is imperative that the emergency physician evaluate for and rule out any potentially associated dangerous conditions such as thyroid storm.

Cardiac Thyrotoxicosis Mimicking an Acute Coronary Syndrome

This case report details the clinical presentation, diagnosis, and multidisciplinary management of a 68-year-old man with cardiac thyrotoxicosis mimicking an acute coronary syndrome (ACS). The patient presented with persistent anginal chest pain, systemic symptoms, and electrocardiographic abnormalities suggestive of ACS. Despite presenting with persistent chest pain and ACS-like symptoms, a thorough examination, including the calculation of the thyrotoxicosis storm (StPRM) score, revealed thyrotoxicosis-induced dilated cardiomyopathy, challenging the initial diagnosis. This specific scoring for thyrotoxicosis severity played a crucial role in accurately identifying the thyrotoxic crisis. The case highlights the intricate relationship between thyroid dysfunction and cardiovascular manifestations, emphasizing the need for a multidisciplinary approach. Management included standard ACS protocols, careful titration of antithyroid medications, and the transition from intravenous to oral heart failure medications. Follow-up assessments demonstrated the success of personalized treatment strategies, with the normalization of thyroid function and complete resolution of the patient's symptoms. Nevertheless, the enduring impairment of left ventricular function following treatment prompts intriguing inquiries into the lasting impact of cardiac thyrotoxicosis on myocardial recovery. However, the persistence of impaired left ventricular function post-treatment raises intriguing questions about the lingering effects of cardiac thyrotoxicosis on myocardial recovery. This case underscores the importance of considering diverse cardiac presentations in hyperthyroid patients and the effectiveness of individualized management approaches in navigating the complexities of thyroid-cardiac interactions.

Psychosis as a Presenting Feature of Thyroid Storm: A Case Report

Psychosis as a Presenting Feature of Thyroid Storm: A Case Report

Emotional Stress-Induced Thyroid Storm

AbstractThyroid storm is an endocrine emergency with high mortality due to severe uncontrolled thyrotoxicosis, often associated with precipitating factors. The chance of survival will increase with early suspicion, prompt diagnosis, and immediate treatment. In this case report, we are presenting a 49-year-old female who came to the emergency department with acute pulmonary edema, agitation, severe tachycardia, high-grade fever with uncontrolled thyrotoxicosis. A diagnosis of thyroid storm was made. The patient presentation was following severe emotional stress after the passing of her mother-in-law. In the literature review, only a few cases reported as emotional stress induced thyroid storm, and we would like to present this life-threatening endocrine emergency.

Total Thyroidectomy while on Extracorporeal Membrane Oxygenation for Thyroid Storm.

The online version contains supplementary material available at 10.1007/s12070-023-04430-9.

Thyroid storm in an uncontrolled graves’ disease with multiple complications: a case report

Thyroid storm is an acute and life-threatening condition. Graves’ disease is the most common cause of thyroid storm. In this case, reported an uncontrolled Graves’ disease patient with multiple complications progressing to thyroid storm. A 33-years-old woman was admitted to the emergency department with agitation. Patient had a history of uncontrolled hyperthyroidism four years ago. From physical examination found exophthalmos, bibasilar rales in both lungs, shifting dullness on stomach, swollen feet, and cold extremities. The ECG showed an atrial fibrillation with rapid ventricular response. Thyroid stimulating hormone (TSH) was found very low with 0.02 mIU/L and very high free thyroxine (FT4) with 5.04 ng/dL. The neck USG showed thyroiditis and bilateral neck lymphadenopathy. The patient was hospitalized for 9 days (4 days in ICCU and 5 days in the general ward). A very high thyroid hormone receptor antibody (TRab) of 35.9 signified a diagnosis of Graves’ disease. The patient had a total Burch-Wartofsky point scale (BWPS) score of 80 and highly suggestive of a thyroid storm. Multiple complications of Graves’ disease are cardiac failure, atrial fibrillation, seizures, vomiting, abdominal cramps, diarrhea, elevated liver enzymes, coma, jaundice, and thromboembolism while in this case the patient had cardiac failure, atrial fibrillation, and elevated liver enzymes. Thyroid storm is diagnosed with clinical features not on laboratory results. It is important to evaluate multiple complications of Graves’ disease as an early warning to reduce the mortality of thyroid storm.

Recurrent impending thyroid storm in a girl with Graves’ disease: a case report

Thyroid storm is an acute, life-threatening, hypermetabolic state in children with thyrotoxicosis. Before the thyroid storm occurs, the patient falls into a “warning stage” called impending thyroid storm. Rapid diagnosis and prompt treatment of an impending thyroid storm are crucial to prevent further life-threatening impacts. We describe a pediatric patient who experienced two episodes of impending thyroid storm with negative COVID-19 tests during the COVID-19 pandemic.

Thyroid disfunction and chronic obstructive pulmonary disease: case report

Common concomitant endocrine diseases in chronic obstructive pulmonary disease (COPD) patients include both structural and functional lesions of the thyroid gland.The purpose of the study was to determine specific indicators for the differential diagnosis of thyroid storm and exacerbation of COPD. A clinical observation of a 60-year-old patient who received inpatient treatment in the therapeutic department of a city clinical hospital is presented. The diagnosis upon admission was COPD, mixed form, severe, exacerbation, and respiratory failure of the first degree.Results. In the hospital, the patient experienced an episode of difficulty breathing lasting 45 minutes. Increased shortness of breath alternated with normal breathing and was accompanied by tremor of the hands. The patient was agitated, refused to breathe oxygen through the mask, and was in orthopnea. The patient’s condition during the attack was assessed at 40 points according to the Burch – Wartofsky scale, which corresponds to a high probability of thyroid storm (TS). Pronounced ventilation disturbances of a mixed type were recorded based on the spirography results (forced expiratory volume in 1 second – 19%). Echocardiography revealed no signs of cor pulmonale or pulmonary hypertension. A low concentration of thyroid-stimulating hormone was recorded, the level of free thyroxine (T4) remained within the reference range. Serum levels of thyroid peroxidase antibodies did not increase, and no changes in the thyroid gland were detected during ultrasound examination.Conclusion. When thyroid abnormality manifests in a patient with COPD, certain difficulties may arise with the differential diagnosis of exacerbation of COPD and TS due to the similarity of their clinical manifestations.

Life-Threatening Endocrinological Immune-Related Adverse Events of Immune Checkpoint Inhibitor Therapy.

Malignant neoplasms are currently one of the leading causes of morbidity and mortality worldwide, posing a major public health challenge. However, recent advances in research in cancer biology and immunity have led to the development of immunotherapy, which is now used on an everyday basis in cancer treatment in addition to surgical treatment, classical cytostatics, and radiotherapy. The efficacy of immunotherapy has promoted the great popularity of this treatment among patients, as well as significant research interest. The increasing number of patients being treated with immunotherapy not only reassures physicians of the efficacy of this technique but also shows the wide spectrum of side effects of this therapy, which has not been considered before. Immune-related adverse events may affect many systems and organs, such as digestive, cardiovascular, respiratory, skin, or endocrine organs. Most complications have a mild or moderate course, but there are life-threatening manifestations that are essential to be aware of because if they are not properly diagnosed and treated on time, they can have fatal consequences. The purpose of this paper was to present the results of a literature review on the current state of knowledge on life-threatening endocrine side effects (such as adrenal crisis, thyroid storm, myxoedema crisis, diabetic ketoacidosis, and severe hypocalcaemia) of immune checkpoint inhibitors to provide information on symptoms, diagnostics, and management strategies.

The Rare Sore Throat: A Case of Thyroid Storm and Agranulocytosis.

Thyroid storm is a rare but potentially life-threatening metabolic disorder that presents unique management challenges in the emergency department. Thionamides are commonly used as monotherapy for first-line treatment of hyperthyroidism. In this case, a 26-year-old male presented to the emergency department with sore throat, fever, and diarrhea. He was found to have thyrotoxicosis as well as methimazole-induced bone marrow suppression resulting in agranulocytosis. Thyroid storm is a rare condition that carries a high risk of mortality and can further compromise a patient's immune system due to complications of common treatment modalities. It can potentially be misdiagnosed as sepsis due to tachycardia, febrile state, and tachypnea. This case report includes a discussion of diagnostic studies, as well as medical and surgical treatment modalities that led to the patient's recovery.