Shock Thyroid in a Patient with Septic Shock: A Case Report and Literature Review

Abstract

Shock thyroid is a rare manifestation of the CT hypotension complex and can be diagnosed when thyroid and perithyroidal edemas are observed on CT during the onset of shock. Shock thyroid can be a useful CT sign for decompensated shock. This condition is reversible and recovers rapidly with adequate treatment. We present the case of an 84-year-old female with septic shock, exhibiting CT features consistent with a shock thyroid. We also reviewed the clinical and radiological findings reported in the literature. The present case emphasizes that shock thyroid can be an early indicator of impending hemodynamic instability and has important prognostic and therapeutic implications.

Multidetector CT Imaging Biomarkers as Predictors of Prognosis in Shock: Updates and Future Directions

“…Thyroid findings are an uncommon, largely unknown part of the CT hypotension complex [ 19 , 21 , 25 , 26 ]. To our knowledge, only eight cases have been reported in the literature [ 77 ]. In their initial description, Brochert et al observed a distinct pattern of heterogeneous hyperenhancement in the thyroid gland, resembling the appearance of a multinodular gland.…”

“…The presumed mechanism is that hypoperfusion of the highly vascular thyroid gland may cause cellular edema or death as well as exudation of intracellular fluid. Other proposed explanations include third-spacing of resuscitative fluid and a profound thyroid response, which induces transient thyrotoxicosis and a swollen gland for the maintenance of cardiac output [ 25 , 77 , 78 , 79 ]. These glandular changes are reversible when associated with successful management of hypovolemia and hypotension [ 77 ].…”

“…Differentiating active blee from pseudoaneurysm formation can be achieved by observing the lobular margin enhancement of the pseudoaneurysm after blood pooling during the arterial Thyroid findings are an uncommon, largely unknown part of the CT hypotension complex [19,21,25,26]. To our knowledge, only eight cases have been reported in the literature [77]. In their initial description, Brochert et al observed a distinct pattern of heterogeneous hyperenhancement in the thyroid gland, resembling the appearance of a multinodular gland.…”

“…Other proposed explanations include third-spacing of resuscitative fluid and a profound thyroid response, which induces transient thyrotoxicosis and a swollen gland for the maintenance of cardiac output [25,[77][78][79]. These glandular changes are reversible when associated with successful management of hypovolemia and hypotension [77].…”