A Rare Case of Subacute Painful Thyroiditis Causing Thyroid Storm and a Successful Trial of Propylthiouracil

Abstract

Thyroid storm is a rare, life-threatening condition characterized by severe or exaggerated clinical manifestations of thyrotoxicosis, commonly occurring in patients with longstanding, untreated hyperthyroidism such as Graves' disease and toxic nodular goiter. Subacute painful thyroiditis, also known as de Quervain thyroiditis, is a self-limited inflammatory disease of the thyroid gland that is characterized by neck pain, a tender diffuse thyroid goiter, elevated inflammatory markers, and a predictable course of thyroid function evolution. Rarely, it can cause thyroid storm. Herein, we report a rare case of a 25-year-old woman who was admitted for sepsis and acute painful thyroiditis who then developed thyroid storm. The patient was treated in the intensive care unit (ICU) and responded very well to steroids, propranolol, a seven-day trial of propylthiouracil, and ultimately achieved a euthyroid state on discharge.

A Case of Thyroid Storm Caused by Thyroiditis

“…We present, to our knowledge, the sixth case in the literature of SAT leading to thyroid storm. 2,3,15-17 In addition, our patient illustrated several atypical features for SAT compared with the previously reported cases. For example, our Doppler ultrasound with diffuse mild hypervascularity without goiter was not typical for SAT, showing no hypoechogenic areas, although it was also inconsistent with Graves disease.…”

“…1 Thyroid storm most frequently occurs in patients with thyrotoxicosis secondary to Graves disease, but may also be associated with thyroid adenoma, toxic multinodular goiter, and in rare cases, subacute thyroiditis (SAT). 2,3 Thyroid storm more commonly develops in patients with underlying thyroid dysfunction and a triggering event such as infection, myocardial infarction, diabetic ketoacidosis, or pregnancy. 4 In the past, thyroid storm was sometimes precipitated by iatrogenic release of thyroid hormone during surgery on a hyperactive gland, but recent advances in surgical and pre-operative techniques have minimized this risk.…”

“…While thyrotoxic symptoms are common in SAT, thyroid storm has only rarely been associated with cases of SAT. 2,3,[15][16][17]…”

A Rare Case of Painless Destructive Thyroiditis Resulting in Thyroid Storm

“…cases of destructive thyroiditis were reported among 356 with thyroid storm (10), although there have been reports of subacute thyroiditis (15)(16)(17)(18)(19) and drug (immune checkpoint inhibitors, amiodarone, or lithium)-induced destructive thyroiditis leading to thyroid storm (1,2). A literature search revealed only one previous report of painless thyroiditis causing thyroid storm (20), indicating that it is extremely rare.…”

Pemphigus vulgaris in an elderly woman diagnosed with subacute thyroiditis: A case report

“…SAT associated human leucocyte antigen (HLA) haplotypes are HLA-B*35, HLA-18:01, DRB1*01, and HLA-C*04:01. 13,14 The HLA haplotype complex cause destruction of the thyroid gland via cytotoxic T lymphocytes. 11 The release of T 4 and T 3 in large quantities results in the hyperthyroidism phase of SAT.…”