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

Abstract

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.

A New Scoring System for Predicting Ventricular Arrhythmia Risk in Patients with Acute Myocardial Infarction

“…We found that patients with hypokalemia are more likely to develop malignant VA, which suggests that electrolyte disorders, especially abnormal blood potassium and magnesium levels, should be intervened during the overall treatment of AMI. 20–22 We also found that type-2 diabetes and baseline creatinine level were also strongly associated with the risk of VA in AMI patients. 23–25 It has been reported that type 2 diabetes predicts a poor prognosis of AMI.…”

Pitfall of Thyroid Storm Score

“…(11) In a thyroid storm, thyroid hormone is secreted in large quantities and increases myocardial cell Na+/K+/ATP activity and is followed by an increase in Ca2+/ATP level activity in the sarcoplasmic reticulum, triggering an increase in oxygen consumption, and causing hypoxia and ischemia resulting in severe arrhythmias. (14)…”