Thyroid storm in a patient with fulminant hepatic failure

Abstract

This manuscript describes a 28-year-old patient with a history of Graves' disease who was transferred to Tulane University Hospital with fulminant hepatic failure. He reported associated nausea, vomiting, anorexia, as well as jaundice and abdominal discomfort for a period of 3 weeks prior to his admission. His thyroid function tests on admission were TSH, 0.013 μU/mL; T3, 94.9 μU/mL; T4, 9.37 μU/mL; Free T4, >6 μU/mL. His liver function tests were characteristic of hepatic failure. The patient underwent an emergent liver transplant. His surgery was complicated by heart failure and acute respiratory distress syndrome. Given the patients clinical presentation and laboratory results, a diagnosis of thyroid storm was made and a decision was made to proceed with an emergent thyroidectomy. The posttransplant multiorgan dysfunction was rapidly reversed by prompt thyroidectomy and decisive management. The patient was discharged from the hospital with normal thyroid and liver function tests.

Severe hyperthyroidism without symptoms due to nonthyroidal illness in a child with acute hepatitis: case report and literature review

“…Although there are multiple case reports of cholestasis and severe liver dysfunction presenting in patients with hyperthyroidism, these are mainly adult patients, many of whom have associated comorbid conditions 33–35,46–49 . Additional causes for the liver dysfunction in these patients may include concomitant autoimmune liver disease, drug‐induced dysfunction from antithyroid medication, and/or sepsis 49 .…”

A Case of Graves’ Disease Complicated With Thyroid Storm and Acute Hepatic Failure

“…There were eight previous reports of Graves' disease complicated with liver failure, and the chief complaints in those cases were caused by Graves' disease. Therefore, this is a rare case in that the liver dysfunction and jaundice primarily appeared before the complication of thyroid storm (Table 2) [5][6][7][8][9][10][11].…”

“…The scientific literature describes some cases of severe cholestasis linked with hyperthyroidism [5][6][7][8][9][10][11]. These cases are often complicated with CHF.…”

Thyroid Storm Presenting as Acute Liver Failure in a Patient with Graves’ Disease

“…Although PTU is considered first-line treatment for thyroid storm, a known side-effect of this medication is ALF via a proposed hypersensitivity reaction. It has been suggested that PTU is the second most common drug following acetaminophen to cause ALF requiring liver transplantation [ 12 ]. Moreover, methimazole has been rarely associated with hepatotoxicity two to twelve weeks after the onset of therapy.…”