Thyroid storm

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-492
Georgina Jorge*1, Joana Menezes Nunes2, Eva Lau3, Ana Varela4, Fernanda Guerra4, Cristiana Paulo4, Luís Lopes5, Manuel Filipe Conceição6 and Davide Carvalho3
1Centro Hospitalar São João; Faculty of Medicine, Porto University, Oporto, Portugal, 2Centro Hosp Sao Joao, Porto, Portugal, 3Centro Hospitalar São João; Faculty of Medicine, Porto University, Portugal, 4Centro Hospitalar São João, 5Centro hospitalar São João, 6Centro Hopsitalar São João
INTRODUCTION: Thyroid storm is a rare, life threatening condition, characterized by severe clinical manifestations of thyrotoxicosis with a mortality of 30-60%. Early recognition and aggressive treatment is essential. Although thyroid storm can develop in patients with longstanding hyperthyroidism, it is often precipitated by an acute event such infection, trauma, etc. We describe a patient with long standing and poorly controlled thyrotoxicosis who presented acutely thyroid storm requiring intensive care.

CASE REPORT: a 59-year-old woman was admitted with a history of fever, episodes of moderate diarrhea, palpitations, tremor, inappropriate affected sweats and disorientation. She had a past history of neurotic depression and Graves´s  disease for ten years, that was self optimally treated with suggestion of poor compliance contributing to this. She admitted  taking propanolol irregularly and  benzodiazepines. She also referred 10kg weight loss. On admission she was apathetic, drowsy, tremulous, pyrexial, in atrial fibrillation, with a fast ventricular rate, tachypneic with evidence of congestive heart failure. She had exophtalmus and eyelid retraction,TVJ ,smoth moderate sized goiter was palpable without any bruit over it. She had a tender right hypocondric and hypogastric without any palpable visceromegalia. Initial investigations revealed sligth liver disfunction, microcitic anemia,moderate thrombocytopenia,  leucocituria, and thyroid functions tests confirmed severe hyperthyroidism .TSH 0.000UI/mL (0.27-4.2) FT4 3.19pg/mL(0.70-1.48) FT3 4.49 ng/dL(1.71-3.71) ALB 21.3 g/L (38-51) AST 53 U/L(10-31) Total billirrubin 2.84 <1.2 glicose 185  PLT 143. The diagnose was acute thyroid storm with multi organ involvement based in a Burch-Wartosfsky point score  scale >60. She was treated in the intensive care unit with propiltiuracil, digoxin , hydrocortisone ,propanolol, paracetamol, amoxicillin, and fluid resuscitation. The clinical course was one of gradual recovery both clinically and biochemistry and she was transferred for the endocrine ward for fully recovering.

CONCLUSION: We present this case because of its severity and rarety and in order to remind the practitioners that thyroid storm can occur, especially in an inadequately treated patient , as in the case described.

Nothing to Disclose: GJ, JMN, EL, AV, FG, CP, LL, MFC, DC

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