scholarly journals (P2-60) Thyroid Storm in the Emergency Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s155-s155
Author(s):  
M.J. Van veelen ◽  
L. Yurtsever ◽  
M. Baggen ◽  
E.A. Dubois
Keyword(s):  
Emergency Department ◽  
Urine Analysis ◽  
Heart Rhythm ◽  
Adult Mortality ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Beta Blockade ◽  
Life Threatening ◽  
The Right ◽  
Cardiac Care Unit

CaseA 20-year-old woman was referred to the emergency department with rapid acceleration of complaints of palpitations, fever, diarrhea, and agitation that had been present for several weeks. During physical examination, the patient was uncomfortable and restless with a tachycardia of 170/minute, and a fever of 38.5 °C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. An electrocardiograph showed an atrial flutter of 150/min. Initial laboratory results showed an erythrocyte sedimentation rate of 35 mm/hour (0–20 mm/hour) and urine analysis tested positive for ketones.Outcome and TreatmentThe patient was presumed to be suffering from a thyroid storm. She was treated promptly with Propranolol 160 mg and Thiamazole 30 mg twice daily at the emergency department. She was admitted to the Cardiac Care Unit for observation of the heart rhythm, which slowed down to 110/minute the same day and her condition improved clinically. The following day her laboratory result confirmed the diagnosis with a thyroid-stimulating hormone of < 0.01 mIU/L (0.4–4.0 mIU/L) and a free thyroxine (T4) of > 75 pmol/l (10–22 pmol/l). Eventually, she was diagnosed with Graves Disease.DiscussionThyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is high (90%) if early diagnosis is not made and the patient is left untreated. Therefore, in case of clinical suspicion for thyroid storm, it is critical to start prompt treatment with Beta blockade and Thiamazole before the diagnosis can be confirmed biochemically.

Thyroid Disease I: Hyperthyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Care Level ◽  
Hypermetabolic State ◽  
Life Threatening ◽  
Overt Hyperthyroidism ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.   This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

scholarly journals THYROID STORM AS A LIFE-THREATENING CONDITION IN THE PRACTICE OF EMERGENCY MEDICAL SERVICE TEAMS

2021 ◽  
Vol 8 (4) ◽  
pp. 260-264
Author(s):  
Agnieszka Ciastkowska-Berlikowska
Keyword(s):  
Thyroid Hormones ◽  
Clinical Symptoms ◽  
Auxiliary Function ◽  
Medical Emergency ◽  
Thyroid Storm ◽  
The Status ◽  
Threatening Condition ◽  
Life Threatening ◽  
Initiation Of Therapy ◽  
The Right

Thyroid storm is a medical emergency. It comprises disorders of several organs and body systems, including disturbances of consciousness (also coma), heart failure, symptoms of shock, and high body temperature. The diagnosis of thyroid storm is challenging because it is based primarily on medical history and physical examination. Additional laboratory tests only perform an auxiliary function, and the initiation of therapy should not be delayed until the determination of thyroid hormones in the blood. Moreover, clinical symptoms often do not correlate with thyroid hormones concentration in the blood. Diarrhea, vomiting, and fever may lead to the diagnosis of thyroid storm. These are not typical symptoms of uncomplicated hyperthyroidism. The remaining symptoms of thyroid storm are symptoms of decompensation of individual organs and systems. When diagnosing thyroid storm, one uses the Burch and Wartofsky criteria. Accurate and quick diagnosis and implementation of initial treatment is the aim of pre-hospital management. These are fluid therapy, oxygen therapy, and antipyretic drugs. For this reason, it is essential not to delay the patient’s transport to the nearest hospital emergency department. One may also consider calling a specialist ambulance with a doctor who can give the right medication on the spot. Rapid treatment initiation can improve the status of most patients within 12-24 hours. Treatment delay worsens, and intensive treatment improves the prognosis in patients with thyroid storm. The mortality rate of thyroid storm has decreased and is now 20-30%.

scholarly journals Thyroid Storm Associated with Testicular Choriocarcinoma

2020 ◽  
Author(s):  
Julio César Martínez ◽  
Ernesto Alfonso Ovalle-Zavala
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Rare Occurrence ◽  
Blood Tests ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Β Hcg ◽  
Very High

Thyroid storm is a rare, life-threatening condition that can be caused by various pathologies including serious conditions associated with human chorionic gonadotropin (hCG)-producing tumours. We present the case of a 17-year-old male patient with a 1-month history of dyspnoea and a 3-day history of palpitations and fever. General examination revealed a left testicular mass. Blood tests revealed β-hCG >225,000 mIU/ml, thyroid-stimulating hormone (TSH) 0.02 IU/ml, and thyroxine (T4) 19.07 µg/dl. He was admitted with thyroid storm. Treatment with antithyroid drugs and chemotherapy was started, but the patient died on the third day of admission. This case highlights a rare occurrence of thyroid storm linked to testicular choriocarcinoma, and provides a necessary reminder that, in some instances, hCG at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of TSH.

Thyroid disease

2018 ◽  
Author(s):  
John Newell-Price ◽  
Alia Munir ◽  
Miguel Debono
Keyword(s):  
Thyroid Gland ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Amiodarone Therapy ◽  
Multinodular Goitre ◽  
Normal Range ◽  
Threatening Condition ◽  
Life Threatening

This chapter addresses six topics in thyroid disease: hypothyroidism; thyrotoxicosis/hyperthyroidism; thyroiditis; amiodarone-induced thyroid disease; thyroid storm; and multinodular goitre and solitary adenomas. Hypothyroidism occurs when there is insufficient secretion of thyroid hormones, commonly caused by autoimmune disease. Subclinical hypothyroidism is when the plasma level of thyroid-stimulating hormone is elevated, but free thyroxine is in the normal range. Myxoedema is severe hypothyroidism with accumulation of mucopolysaccharides in the dermis and other tissues. Thyrotoxicosis results from exposure to excessive thyroid hormone. The term ‘hyperthyroidism’ denotes those conditions in which thyroid hyperfunction results in thyrotoxicosis. Thyroiditis is inflammation of the thyroid gland, and often leads to transient thyrotoxicosis followed by hypothyroidism. Abnormalities of the thyroid occur in up to half of those on amiodarone therapy, with both thyrotoxicosis and hypothyroidism. Thyroid storm occurs as a result of exacerbation of thyrotoxicosis, and is a rare but life-threatening condition. Thyroid nodules are common, and may be multiple or single, functioning or non-functioning, and benign or malignant.

Thyroid storm as an early presentation of hCG-producing metastatic choriocarcinoma: a case report and review of the literature

2021 ◽  
Vol 14 (9) ◽  
pp. e242868
Author(s):  
Krishna Karthik Chivukula ◽  
David Toro-Tobón ◽  
Banafsheh Motazedi ◽  
Rachna Goyal
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Free T4 ◽  
Early Presentation ◽  
Iodinated Contrast ◽  
Short Course ◽  
Nausea And Emesis ◽  
The Right ◽  
Upper Abdomen ◽  
Subclinical Thyrotoxicosis

Human chorionic gonadotropin (hCG)-induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ cell tumours and usually presents with mild symptoms or subclinical thyrotoxicosis. We present a case of a young adult man who consulted with abdominal pain, nausea and emesis. On admission, he was found to be tachycardic, febrile, anxious and with icteric sclera and tenderness to palpation in the right upper abdomen. A right scrotal mass was also noted. Initial studies revealed transaminitis, hyperbilirubinaemia, suppressed thyroid-stimulating hormone and elevated free T4. Scrotal biopsy confirmed diagnosis of testicular choriocarcinoma with an elevated hCG level of 6074 mIU/mL, which was corrected to 6 760 713 mIU/mL when reassessed with dilution. The clinical scenario reflected hCG-induced thyrotoxicosis concerning for thyroid storm. Euthyroid state was restored after initiation of chemotherapy and a short course of methimazole. Unfortunately, the patient passed away due to progression of his malignant disease. This case suggests that when choriocarcinoma is suspected, the use of iodinated contrast agents should be limited to avoid precipitation of thyroid storm or worsening of hCG-induced hyperthyroidism. Moreover, if the clinical picture does not support a primary aetiology of hyperthyroidism and hCG is not concordantly elevated, reassessment of hCG by dilution should be considered as hCG assays are subject to prozone effect.

Ovarian vein thrombosis: a potential clinical consequence of ruptured ectopic pregnancy

2021 ◽  
Vol 14 (4) ◽  
pp. e240940
Author(s):  
David Elliot Teytelbaum ◽  
Josh Dean Meade ◽  
Jennifer Swanson
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Clinical Consequence ◽  
Ovarian Vein ◽  
Timely Manner ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
The Right ◽  
Ovarian Vein Thrombosis

A healthy 32-year-old G3P3 woman with an unknown last menstrual period presented to the emergency department with intense abdominal pain and pain in the right chest that radiated down the right arm. Further workup showed that she had a ruptured ectopic pregnancy with significant haemoperitoneum. After successful laparoscopic evacuation of the ectopic pregnancy and haemoperitoneum, the patient subsequently developed a right ovarian vein thrombosis 4 weeks after the procedure. She was treated with anticoagulation, and further haematological studies did not show any significant findings. Postpartum ovarian vein thrombosis is extremely rare and can be life- threatening if not accurately diagnosed and treated with anticoagulation or surgical management in a timely manner.

scholarly journals Thyroid Storm, Rhabdomyolysis, and Pulmonary Embolism: An Unusual Triad Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 540-543
Author(s):  
Montane Silverman ◽  
Jesse Wray ◽  
Rachel Bridwell ◽  
Amber Cibrario
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Male Patient ◽  
Medical Emergency ◽  
Thyroid Storm ◽  
Diagnosis And Management ◽  
Difficult Diagnosis ◽  
Life Threatening ◽  
Significant Mortality

Introduction: Thyroid storm is a medical emergency associated with significant mortality. Hyperthyroid states have been associated with hypercoagulability as well as rhabdomyolysis. However, the pathophysiology of this association remains under investigation. Case Report: A 62-year-old male patient presented to the emergency department with weakness and was found to have thyroid storm with concurrent submassive pulmonary embolisms and rhabdomyolysis. To our knowledge, this is the first reported presentation of this triad. Conclusion: This case highlights the potentially difficult diagnosis and management of thyroid storm, as well as associated life-threatening complications, including venous thromboemboli and rhabdomyolysis.

scholarly journals Management of Atrial Flutter in Thyroid Storm

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A941-A941
Author(s):  
Theresa N Lanham ◽  
Farah Hena Morgan
Keyword(s):  
Atrial Flutter ◽  
Hot Flashes ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Beta Blockade ◽  
Free T4 ◽  
Free T3 ◽  
History Of

Abstract Introduction: Thyroid storm, life-threatening hyperthyroidism, commonly presents with tachyarrhythmias. We present a case of hyperthyroid-induced atrial flutter, refractory to beta-blockade, successfully treated with electrical cardioversion (CV) while biochemically hyperthyroid. Case Description: A 49-year-old female with history of asthma and no family or personal history of thyroid disease presented with new-onset atrial flutter and heart failure. The patient endorsed weight loss, hot flashes, anxiousness, tremors, and palpitations. She denied gastrointestinal symptoms or visual changes. She was afebrile with normal mentation. Heart rate was found to be 260 beats per minute (bpm) in atrial flutter. Exam demonstrated bilateral lower extremity edema, and profound exophthalmos. Labs were remarkable for thyroid stimulating hormone (TSH) &lt;0.01 [ref: 0.27-4.2] uIU/mL, free T4 4.5 [ref: 0.8-1.8] ng/dL, free T3 15.5 [ref: 2.0-4.4] pg/mL, thyroid stimulating immunoglobulin (TSI) of 379 [ref: &lt;140] % and a thyroid receptor antibody (TRab) of 10.02 [ref:&lt;=2.0] IU/L. White blood cell count and liver function tests were normal. Chest x-ray (CXR) showed bilateral pulmonary edema and ultrasound showed an enlarged heterogeneous hypervascular thyroid gland. The patient was initially started on Methimazole 30 mg daily and Metoprolol 25 mg every six hours but on day two, the patient was transitioned to Propylthiouracil (PTU) 250 mg every 6 hours given continued atrial flutter and concern for thyroid storm given Burch-Wartofsky score was 50. She was also given potassium iodide for three days. Cardioversion was deferred, as it was felt that the severity of thyrotoxicosis would limit success. On day six, TFTs were improved with a free T4 of 2.2, free T3 3.6. On day 8, because of continued tachycardia &gt;130 bpm with limitation of beta-blockade due to hypotension, she underwent a cardioversion which was successful. On discharge, free T4 was 1.7 and she was transitioned to Methimazole 40 mg daily. Discussion: Thyroid storm has a mortality rate of 10-20%, often related to tachyarrhythmias which can be difficult to treat during a hyperthyroid state. Tachycardia should initially be treated with beta-blockade and antithyroid therapy. Amiodarone is avoided due to concern for worsening hyperthyroidism. A literature review suggests that electrical CV should not be attempted until a patient is euthyroid for four months, as a majority will spontaneously revert once thyroid levels normalize. Conversely, other studies have found that the rate of recurrence of atrial fibrillation between clinically hyperthyroid and euthyroid patients was not statistically significant, suggesting CV should not be delayed until a patient is euthyroid. This suggests that further studies need to be completed to better elucidate appropriate timing in hyperthyroid patient’s refractory to pharmacologic treatment alone.

scholarly journals Evaluation and Treatment of Elevated Temperature in the Emergency Department

2020 ◽  
Author(s):  
Marina Boushra
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Elevated Temperature ◽  
Vital Sign ◽  
Source Control ◽  
Thyroid Storm ◽  
Improved Outcomes ◽  
Life Threatening ◽  
Abdominal Infections ◽  
Sepsis And Septic Shock

Elevated patient temperature is a common vital sign abnormality in the emergency department that can be caused either by fever or hyperthermia. Fever is a frequent presentation, most commonly caused by infections of the respiratory or urinary tracts. Other occult sources include musculoskeletal, cardiac, neurological, and intra-abdominal infections. These infections can become complicated by sepsis and septic shock, conditions with high mortality. Treatment of the febrile acutely-ill patient should begin with fluids, antimicrobials, and source control. However, if this is ineffective or if the presentation is inconsistent with infection, consideration should be given to hyperthermia, rather than fever, being the cause of the patient’s elevated temperature. Several life-threatening and reversible conditions can mimic sepsis and present with elevated temperature. These mimics include toxicity from medications and illicit substances, neuroleptic malignant syndrome, malignant hyperthermia, and thyroid storm. Identification of these mimics as the source of elevated temperature can lead to earlier diagnosis and improved outcomes in these patients.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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