Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Poster Board SAT-492
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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