Hypoglycemic Coma Masquerading Thyrotoxic Storm.

Abstract

A 59-year-old womanwas hospitalized in hypoglycemic coma. Although hypoglycemia was promptly reversed, she was in a somnolent, restless state with tachycardia, tremor, profuse sweating, and high body temperature. Thyrotoxic storm was highly suspected and vigorous antithyroid regimens gradually brought her up to normal mental and cardiovascular states in several days. However, profound generalized myopathy necessitated the maintenance with a respirator. One month later, an episode of angina pectoris was followed by generalized convulsion, coma, and death in a few days. Neuroimaging study disclosed posterior leukoencephalopathy syndrome.This case is instructive in that hypoglycemiccomamaymasqueradethe major symptomatology of thyrotoxic storm, and that profound myopathy and angiopathic or angiospastic processes of the brain and the heart may interfere with the outcome. (Internal Medicine 38: 871-874, 1999)

Severe Starvation Hypoglycemia and Congestive Heart Failure Induced by Thyroid Crisis, with Accidentally Induced Severe Liver Dysfunction and Disseminated Intravascular Coagulation

“…First, we gave attention to the most prominent feature, unconsciousness, which could be induced by severe hypoglycemia. In a thyroid crisis hyperglycemia has been well known (6)(7)(8), but hypoglycemia has been rarely reported (8,9). In the latter case, an extremely emaciated state or reduction in the adrenal reserve was noted.…”

“…Starvation for more than 2 weeks could induce deficiency of substrate for gluconeogenesis. Severe malnutrition combined with thyrotoxicosis should induce hypoglycemia (9). Alternatively, hypoglycemia may precipitate a thyroid crisis (6)(7)(8).…”

“…In addition to cardiovascular manifestations, mild liver dysfunction and gastrointestinal symptoms including strong nausea, vomiting, diarrhea and loss of appetite frequently occur even in the early phase of a thyroid crisis (4,5). On the other hand, mild to moderate hyperglycemia is common in a thyroid crisis (6)(7)(8), but hypoglycemia is unusual (9).…”

A Case of Atypical Thyroid Storm with Hypoglycemia and Lactic Acidosis

“…Thyroid storm with hypoglycemia has rarely been reported [7,8]. complications such as those seen in our patient are certainly uncommon, but the literature does show that this condition can have a variety of causes.…”

A Patient with Thyroid Storm Presenting with Apathetic Thyrotoxicosis and Features of Meningoencephalitis

“…The majority of the patients were women. Their age ranged from 3 to 77 years of age, but occurrences were most common between the 4th and 6th decades (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”