Severe Thyrotoxicosis (Thyroid Storm) With Liver Failure

2007 ◽  
Vol 6 (1) ◽  
pp. 30-32
Author(s):  
Victor Oguntolu ◽  
Keyword(s):  
Liver Failure ◽  
Thyroid Disease ◽  
Hepatic Dysfunction ◽  
Severe Form ◽  
Thyroid Storm ◽  
Prior History ◽  
Life Threatening ◽  
History Of ◽  
Background History ◽  
Uncommon Condition

Thyroid storm is a severe form of thyrotoxicosis. It is an uncommon condition but can be life-threatening. Most often it is seen in patients with a background history of thyroid disease and most cases are complicated with multi-organ involvement, mainly respiratory, cardiovascular, hepatic and renal. The association of severe thyrotoxicosis with severe hepatic dysfunction has been rarely reported. This case describes a 34-year-old male without a known prior history of thyroid disease who presented with severe liver failure.

Pathophysiology and causes of acute hepatic failure

2016 ◽  
Author(s):  
Sameer Patel ◽  
Julia Wendon
Keyword(s):  
Liver Failure ◽  
Cerebral Oedema ◽  
Acute Hepatic Failure ◽  
Clinical Syndrome ◽  
Prior History ◽  
Drug Induced ◽  
Disease Mortality ◽  
Haemodynamic Changes ◽  
Life Threatening ◽  
History Of

Acute liver failure (ALF) is a rare, life-threatening clinical syndrome, resulting in loss of hepatic metabolic and immunological function, in a person with no prior history of liver disease. Mortality can still exceed 50%. ALF is characterized by hepatic encephalopathy (HE) and coagulopathy, occurring within days or weeks. Establishing aetiology is essential for treatment, prognostication, and liver transplantation consideration. Viral hepatitis and drug-induced liver failure are the two commonest causes worldwide. Aetiology and time of onset of encephalopathy determines prognosis. Disease progression can rapidly result in multi-organ failure. Ammonia has been postulated in the development of HE, cerebral oedema and intracranial hypertension. Coagulopathy can be highly variable, with some patients prothrombotic, or exhibiting balanced coagulation disorders. Systemic inflammatory response syndrome (SIRS) and associated infection are frequently observed. Significant haemodynamic changes are common while renal failure is an independent risk factor for mortality. Respiratory failure is less common. Deranged homeostasis results in severe hypoglycaemia, and metabolic disturbance.

scholarly journals SAT-492 Impending Thyroid Storm Induced by Checkpoint Inhibitors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ya Zhou ◽  
Kathryn Jobbins ◽  
Raju Panta
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Nodular Goiter ◽  
Thyroid Storm ◽  
Prior History ◽  
Free T4 ◽  
Threatening Condition ◽  
Life Threatening

Abstract Introduction: Thyroid storm is a rare but life threatening condition due to thyroid hormone excess and is usually caused by Graves disease, toxic nodular goiter or rarely due to thyroiditis. Immune checkpoint inhibitors (ICI) are a novel choice for treating cancers, and carry a risk for development of endocrinopathies. We report a case of impending thyroid storm 5 weeks after initiation of ICI. Case Presentation: 81-year-old Caucasian male with metastatic renal cell carcinoma presented with generalized weakness and fatigue 5 weeks after ipilimumab and nivolumab were started. He had no prior history of thyroid disease and had normal thyroid functions before the treatment. He complained of palpitations, heat intolerance and loose stools on admission. On examination he was disoriented, tachycardic (128bpm) with new onset atrial fibrillation, had moist skin and brisk reflexes. He had non-tender thyroid, no thyromegaly, and no nodules palpated. Burch-Wartofsky score was 35, suggesting impending thyroid storm. Laboratory investigation showed elevated free T4 (>7.77), elevated free T3 (8.6) with a suppressed TSH (< 0.02). He had positive anti-TPO but Thyrotropin receptor antibody was negative. He was treated with propranolol 40 mg three times daily, prednisone 40 daily, methimazole 30mg three times a day with significant improvement in free T4 (5.67) within first 48 hours. Discussion: Imipimumab and nivolumab are monoclonal antibodies against cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed death receptor-1 (PD-1) respectively. The reported incidence of thyroid dysfunction after combined imipimumab and nivolumab therapy can be as high as 22%1. Thyroiditis could present as early as 2-6 weeks 2 after treatment, and hypothyroidism tends to present between 5 months and 3 years3. According to a current consensus4, baseline TSH and FT4 should be drawn prior to initiating ICI. Thyroid storm is a clinical diagnosis and Burch-Wartofsky score can help in diagnosis. A high degree of suspicion and prompt diagnosis of thyroid storm and treatment is of utmost importance especially in this patient population. Rapid improvements in thyroid hormone levels suggest thyroiditis as a potential cause for thyrotoxicosis. Conclusion: ICI induced thyroid disease is not an uncommon condition. It could present as either thyrotoxicosis or hypothyroidism. Both patient and clinician should be aware of potential signs and symptoms of thyroid storm for early recognition and timely treatment of this life-threatening condition. [1] Byun DJ et al.Nat Rev Endocrinol. 2017 Apr;13(4):195-207 [2] Iyer PC et al. Thyroid. 2018 Oct;28(10):1243-1251 [3] Endocr Relat Cancer. 2014 Mar 7;21(2):371-81 [4] Puzanov et al. Journal for ImmunoTherapy of Cancer (2017) 5:95

scholarly journals Report of a Rare Case of Trauma-Induced Thyroid Storm

2002 ◽  
Vol 81 (8) ◽  
pp. 570-574 ◽  
Author(s):  
Neil M. Vora ◽  
Fred Fedok ◽  
Brendan C. Stack
Keyword(s):  
Nervous System ◽  
Rare Case ◽  
Hepatic Dysfunction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Definitive Treatment ◽  
Thyroid Storm ◽  
Vehicle Accident ◽  
Hyperthyroid State ◽  
Life Threatening

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.

scholarly journals Acquired Factor XI Inhibitor Presenting as Spontaneous Bilateral Subdural Hematoma in an Elderly Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Natale Vazzana ◽  
Luca Scarti ◽  
Chiara Beltrame ◽  
Antonella Picchi ◽  
Gianni Taccetti ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Coagulation Factors ◽  
Spontaneous Bleeding ◽  
Autoimmune Conditions ◽  
Life Threatening ◽  
History Of ◽  
Uncommon Condition ◽  
High Degree ◽  
History Of Cancer ◽  
Mucocutaneous Bleeding

Development of autoantibodies against coagulation factors is an uncommon bleeding disorder associated with cancer, autoimmune conditions, pregnancy, or no apparent disease. Spontaneous FVIII inhibitors are the most frequently encountered; those against FXI have been only anecdotally reported. We report a case of acquired FXI inhibitor presenting as fatal intracranial spontaneous bleeding in an elderly patient with history of cancer and previous transfusions. Few cases of acquired FXI inhibitor have been reported in association with connective tissue disease, cancer, or surgery. Bleeding includes mucocutaneous bleeding, postsurgical hemorrhage, or life-threatening events. Treatment consists of arresting the bleeding and inhibitor eradication. High degree of suspicion is essential to promptly diagnose and treat this uncommon condition.

scholarly journals Emphysematous pyelonephritis with Dengue hemorrhagic fever: A successful medical management of a fatal scenario

2017 ◽  
Vol 8 (5) ◽  
pp. 101-103
Author(s):  
Robin George Manappallil ◽  
Prathap Reddy Muthyala
Keyword(s):  
Dengue Fever ◽  
Hemorrhagic Fever ◽  
Severe Form ◽  
Medical Sciences ◽  
Emphysematous Pyelonephritis ◽  
Associated Gas ◽  
Acute Necrotizing ◽  
Life Threatening ◽  
History Of ◽  
Plasma Leakage

Emphysematous pyelonephritis is a life threatening acute necrotizing infection with associated gas formation involving the renal parenchyma and perinephric tissues. Dengue fever, according to the WHO, is the most rapidly spreading mosquito borne viral infection in the world. Dengue Hemorrgahic Fever is a more severe form of dengue fever and is characterized by fever, bleeding manifestations, plasma leakage and thrombocytopenia. This is a case of a 56 year old female, who presented with history of fever, headache, myalgia and dysuria; and was diagnosed to have emphysematous pyelonephritis with Dengue Hemorrgahic Fever. She was successfully managed with intravenous antibiotics and platelet transfusions, without any urological interventions. Asian Journal of Medical Sciences Vol.8(5) 2017 101-103

Reconstruction of a Previously Repaired Aortic Valve Destroyed by Infective Endocarditis: Case Report

2016 ◽  
Vol 8 (3) ◽  
pp. 408-410
Author(s):  
Tomas Chalela ◽  
Viktor Hraska
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Case Report ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Congenital Heart ◽  
Congenital Aortic Stenosis ◽  
Life Threatening ◽  
History Of ◽  
Uncommon Condition

Infective endocarditis (IE) is an uncommon condition among patients with congenital heart disease, however it can be life threatening. The usual management includes replacement of the affected valve, especially in patients with aortic valve compromise, and is even more common in previously repaired valves. In this case report, we describe the successful reconstruction of an aortic root destroyed by IE, in a patient with history of ballooning of a congenital aortic stenosis.

Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review

1996 ◽  
Vol 41 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Gb Meterissian
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Features ◽  
Prior History ◽  
Extrapyramidal Side Effects ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication ◽  
The One

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. Methods: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. Results: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. Conclusions: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.

scholarly journals A rare case scenario: spontaneous diaphragmatic rupture during labor

2021 ◽  
Vol 8 (7) ◽  
pp. 2241
Author(s):  
Shambhu Nath Agrawal ◽  
Amit Verma ◽  
Sunil Kedia ◽  
Amol Padegaonkar ◽  
Hari Shankar Mahobia
Keyword(s):  
Surgical Intervention ◽  
Hepatic Flexure ◽  
Diaphragmatic Rupture ◽  
Prior History ◽  
Case Scenario ◽  
Term Delivery ◽  
Life Threatening ◽  
History Of ◽  
Full Term Delivery ◽  
Complications And Mortality

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

scholarly journals Under the Radar: A Case Report of a Missed Aortoenteric Fistula

2021 ◽  
Vol 5 (3) ◽  
pp. 312-315
Author(s):  
Blake Briggs ◽  
David Manthey
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Imaging Modality ◽  
Aortic Surgery ◽  
Aortoenteric Fistula ◽  
Prior History ◽  
Gi Bleeding ◽  
Life Threatening ◽  
History Of ◽  
Widespread Availability

Introduction: An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report: Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion: Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.

Neurological and gastrointestinal symptoms as an initial presentation of pediatric thyroid storm: report of three cases

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Masao Nogami ◽  
Shadia Constantine ◽  
Shuji Sai
Keyword(s):  
Gastrointestinal Symptoms ◽  
Antithyroid Drug ◽  
Severe Case ◽  
Initial Presentation ◽  
Thyroid Storm ◽  
Gi Symptoms ◽  
Old Japanese ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Abstract Objectives Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves’ disease. Case presentation They were previously healthy adolescents without family history of thyroid disease. CNS symptoms varied from agitation to coma. GI symptoms included abdominal pain, vomiting, and diarrhea. Their laboratory studies revealed thyrotoxicosis and positive result of thyroid-stimulating antibody (TSAb). They were admitted to the intensive care unit (ICU) and received the combination of an antithyroid drug, Lugol’s solution, a beta antagonist, and hydrocortisone. The most severe case was a 13 year-old Japanese girl who presented with loss of consciousness and hemodynamic shock. She died after 5 days of intensive treatment. Conclusions Pediatricians should consider TS in the differential diagnosis when a patient exhibits both CNS and GI symptoms.

Sign in / Sign up

Export Citation Format

Share Document