A case of thyroid storm with cardiac arrest

Nakashima, Yutaka; Kenzaka, Tsuneaki; Okayama, Masanobu; Kajii, Eiji

doi:10.2147/imcrj.s63475

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…In our literature review, a total of 9 patients with thyroid storm had no underlying heart disease or hypokalaemia but had malignant arrhythmias. [3][4][5][6][7] Ventricular tachycardia has been registered in hyperthyroid patients suffering from Grave's disease and it has been associated with the interaction of autoantibodies of the 1-adrenergic, the M2 muscarinic, and the TSH-receptors. 3 So we consider two possibilities likely.…”

Section: Dovepressmentioning

confidence: 99%

<p>Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm</p>

Shang

2020

IJGM

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Thyroid storm is usually due to a severe exacerbation of a preexisting thyrotoxicosis, which later leads to decompensation in different organ systems. Thyroid storm with malignant arrhythmia is rare, but the mortality rate is high. Malignant arrhythmia has usually occurred in some patients with hypokalemia or ischemic heart disease. The presentation of these arrhythmias in the initial phase of the disease is much less common, and only a few isolated cases are described in the scientific literature. This paper analyzes and summarizes the clinical characteristics of this disease through literature reviews, for clinicians early detection and diagnosis of this disease. We report a 51-year-old woman with diarrhoea, fever, thyroid storm, ventricular fibrillation and no potential heart disease. The case report is discussed using relevant data from literature. A total of 9 patients were reported in the literature, totalling 10 cases with ours, including 7 cases of ventricular fibrillation and 3 cases of ventricular tachycardia. Most of the treatments were antithyroid drugs, hormones and beta-receptor blockers, and 3 death cases. Patients with thyroid crisis need to be closely monitored for malignant arrhythmias. Early diagnosis and treatment may save lives.

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Section: Dovepressmentioning

confidence: 99%

<p>Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm</p>

Shang

2020

IJGM

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“…HF with low CO has been reported with prolonged severe hyperthyroidism, consequent to persistent tachycardia, and pathologic increase in cardiac workload with demand-supply mismatch ( 42 ). Aside from cardiomyopathy, there is an increased risk of arrhythmias with thyrotoxicosis, typically supraventricular, with rare reported cases of thyrotoxicosis-related VF related to congenital coronary anomalies, hypokalemia, coronary vasospasm and early repolarization ( 43 ), none of which were present in our patient. It is plausible that our patient had low CO thyrocardiac disease with an additional component of myocardial stunning post-cardiac arrest, but his stormy course precluded detailed cardiac imaging.…”

Section: Discussionmentioning

confidence: 69%

Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems

et al. 2021

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Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.

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“…Drug-induced TS: We found a few cases of amiodarone-induced TS that led to cardiomyopathy and CS [37,43,173]. Amiodarone is a class III antiarrhythmic drug with iodine content used to treat tachyarrhythmia, in around 14-18% of patients; it may result in amiodarone-induced thyrotoxicosis (AIT) [244].…”

Section: Discussionmentioning

confidence: 99%

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Elmenyar,

Aoun,

Al Saadi

et al. 2023

Diagnostics

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Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch–Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.

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A case of thyroid storm with cardiac arrest

Cited by 8 publications

References 11 publications

<p>Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm</p>

<p>Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm</p>

Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

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