An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis

Takahashi, Motonori; Kondo, Takeshi; Yamasaki, Gentaro; Sugimoto, Masaharu; Kuse, Azumi; Morichika, Mai; Nakagawa, Kanako; Ueno, Yoshio

doi:10.1016/j.legalmed.2019.101624

Cited by 3 publications

(2 citation statements)

References 27 publications

(34 reference statements)

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“…7 The heart in cases of thyrotoxicosis usually shows all or some features consequent to a sustained increase in work, such as cardiac hypertrophy and ventricular dilatation, accompanied by microscopic myocyte hypertrophy with or without interstitial edema or fibrosis. [8][9][10] Of note, thyroid storm does not show additional specific pathologic features in the heart beyond what may be seen in cases of thyrotoxicosis below the threshold for a diagnosis of thyroid storm.…”

Section: Discussionmentioning

confidence: 95%

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Ricciardo

Hastings

2023

Am J Forensic Med Pathol

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Thyroid storm, or thyrotoxic crisis, is a rare but well-described and potentially lethal exacerbation of thyrotoxicosis, characterized by multisystem effects due to failure of the hypothalamic-pituitary-thyroid axis. Thyroid storm is seen most frequently in the setting of inadequately treated Graves disease; however, it may also be triggered or exacerbated by infection, trauma, childbirth, radioiodine treatment, and pharmacologic agents. While there are rare reports of cases in which illicit drug use may have triggered or exacerbated thyroid storm, none specifically involving synthetic cannabinoids have been previously described. We present the case of a 25-year-old man who presented with thyroid storm in the setting of poorly controlled Graves disease and synthetic cannabinoid use.

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Section: Discussionmentioning

confidence: 95%

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Ricciardo

Hastings

2023

Am J Forensic Med Pathol

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“…Most cases of TS are caused by the presence of some triggering condition in conjunction with an underlying thyroid condition. This usually involves untreated or uncontrolled GD but may rarely be due to thyrotoxic disorders such as chronic lymphocytic thyroiditis ( 12 , 13 , 14 ). The differential diagnosis of hyperthyroidism in this case can be challenging.…”

Section: Discussionmentioning

confidence: 99%

Acute adrenal crisis precipitated by thyroid storm in a patient with undiagnosed autoimmune polyglandular syndrome type 2

Lassoued¹,

Alaya²,

Rebai³

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Autoimmune polyglandular syndrome (APS) type 2 is characterized by the presence of Addison’s disease (AD) along with autoimmune thyroid disease and/or type 1 diabetes. APS type 2 is known as Schmidt’s syndrome when autoimmune adrenal insufficiency is associated with chronic lymphocytic thyroiditis. We report a very rare case of a 28-year-old female patient who had Schmidt’s syndrome revealed by a thyroid storm (TS) concomitant with an acute adrenal crisis. The onset of AD resulted in a surgical emergency. The patient presented with cardiogenic shock and an acute abdomen. The precipitation factor was Hashitoxicosis presented as TS. This life-threatening condition was successfully reversed with aggressive medical therapy based on antithyroid drugs and intravenous glucocorticoids. This hyperthyroid phase lasted for a period of 8 months. The patient eventually developed hypothyroidism, suggesting that Hashimoto's thyroiditis was the most likely diagnosis. She was started on levothyroxine replacement therapy and remained euthyroid on levothyroxine. The case we describe had several diagnostic pitfalls that are discussed both at the start as well as during the evolution. Learning points Autoimmune diseases can appear concomitantly or succeed each other over time. The clinician must be vigilant to detect these diseases in time in order to avoid a misdiagnosis of a life-threatening emergency such as adrenal insufficiency or thyroid storm. Thyroid storm is an uncommon but life-threatening manifestation of hyperthyroidism. Diagnosis is dependent on clinical symptoms, and no specific laboratory tests are available. Glucocorticoids should be used in the treatment of thyroid storm because they have an inhibitory effect on peripheral conversion of T4 to T3. In patients who have severe thyrotoxicosis, especially in conjunction with hypotension, treatment with glucocorticoids has become standard practice because of the possibility of relative adrenal insufficiency or the possibility of undiagnosed Addison’s disease. The differential diagnosis of hyperthyroidism can be challenging. Graves’ disease can be discussed in view of the severity of the clinical presentation and the prolonged duration of the hyperthyroid phase. Hashitoxicosis is the initial hyperthyroid phase in chronic autoimmune thyroiditis. The hyperthyroid phase is always followed by definitive resolution, with persistent euthyroidism and no hyperthyroid relapses. Synthetic antithyroid drugs may be prescribed during the hyperthyroid phase of Hashimoto thyroiditis if the clinical presentation is severe and the duration of the hyperthyroid phase is prolonged.

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A case of fatal tracheal compression in a patient with Hashimoto's disease under the setting of previous tracheostomy

Sonoda,

Shinkawa,

Kakizaki

et al. 2023

Forensic Science International: Reports

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An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis

Abstract: An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis

Cited by 3 publications

References 27 publications

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Acute adrenal crisis precipitated by thyroid storm in a patient with undiagnosed autoimmune polyglandular syndrome type 2

A case of fatal tracheal compression in a patient with Hashimoto's disease under the setting of previous tracheostomy

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