Thyroid storm presenting as septic shock in the intensive care unit: A Case Series

Keyal, Niraj Kumar; Pokharel, Niru; Khanal, Sudesh

doi:10.31729/jnma.4552

Cited by 3 publications

(4 citation statements)

References 7 publications

(10 reference statements)

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“…If these patients had undergone thyroid hormone measurements when their mental or physical statuses had changed, we might have been able to detect and treat their thyroid conditions earlier. CNS manifestations of thyroid storm may include restlessness, delirium, mental aberration, somnolence, convulsions, and coma (Ishihara et al, 2019;Keyal et al, 2020). However, depression, hypomania, and anxiety disorders are the most frequently reported psychiatric findings in patients with hyperthyroidism.…”

Section: Resultsmentioning

confidence: 99%

Impending tyroid storm

Prameswari¹,

Fadli²

2022

midwifery

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Thyroid storm is an emergency and requires immediate treatment. Diagnosing thyroid storm is difficult because of its clinical symptoms that mimic infection such as tachycardia, high fever, and sometimes shortness of breath. This study employs a case study approach. The research subjects were patients with impending thyroid storm. The research location is in the Emergency Unit of Cibinong Hospital. Data analysis techniques using literature studies. In this case, a 30-year-old man at the Emergency Unit of Cibinong Hospital presented a clinical Impending Thyroid Storm with multi-organ involvement including Thyroid Heart Disease in the form of Atrial Fibrillation, gastrointestinal complaints, Hypoglycemia accompanied by Respiratory Failure. The patient has been diagnosed with Graves Disease for 5 years. Treatment for this patient includes correction of hypoglycemia, diuretics and digoxin. Propylthiouracil (PTU) and Propranolol were given when the FT4 and TSH results were out. After being treated with this therapy, clinically improved, marked by reduced tightness, fever and palpitations. On the ecg examination, atrial fibrillation was not found again. Recognizing Thyroid Storm as early as possible can prevent the severity of complications. Hypoglycemia correction is no less important. PTU therapy, Propranolol, Furosemide, Spironolactone and Digoxin are still good therapeutic modalities to be used, especially in type B hospitals.

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Section: Resultsmentioning

confidence: 99%

Impending tyroid storm

Prameswari¹,

Fadli²

2022

midwifery

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“…Trauma, drugs, and sepsis have been reported to lead to this potentially life-threatening complication [ 3 ]. In a case series, other identified etiologies included chest infection, urinary tract infection, and meningitis [ 4 ]. Each patient had reported some level of thyroid pathology including thyroid swelling, bilateral pedal edema, and jaundice, while only one patient had a history of hyperthyroidism [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…In a case series, other identified etiologies included chest infection, urinary tract infection, and meningitis [ 4 ]. Each patient had reported some level of thyroid pathology including thyroid swelling, bilateral pedal edema, and jaundice, while only one patient had a history of hyperthyroidism [ 4 ]. Another case discussed a patient with a past medical history of uncontrolled hyperthyroidism and congestive heart failure who was later found to have a toxic goiter.…”

Section: Introductionmentioning

confidence: 99%

Anchoring on Hyperglycemia and Sepsis in the Presence of an Unforeseen Thyroid Storm

Joseph,

Karas,

Camba

et al. 2023

Cureus

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Thyroid storm (TS) is a relatively rare but life-threatening complication of an overactive thyroid that can manifest in a myriad of ways due to its multisystem involvement. Due to its relatively high mortality rate, it is essential that TS is recognized and treated promptly. TS can occur due to trauma, drugs, and sepsis. Identifying TS as a diagnosis is challenging to pinpoint due to its similar presentation to more common pathologies like sepsis and diabetic ketoacidosis (DKA). Here, we present a case of a 31-year-old African-American woman with type 2 diabetes mellitus following sepsis secondary to Escherichia coli pyelonephritis and DKA. Despite standard sepsis treatment, which included appropriate intravenous fluids and antibiotics, the patient did not improve. Further workup, utilizing the Burch-Wartofsky score, helped identify TS as the underlying cause of the patient’s hospitalization, despite no history of underlying thyroid disease. The inclusion of thyroid pathology as part of the differential diagnosis and workup of a patient with a sepsis-like presentation to avoid anchoring bias warrants further investigation.

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“…Thyroid hormones have an impact on every system of the body. Muscle and central nervous system (CNS) excitability are all increased by thyroid hormones, along with metabolic rate, heart rate, and ventricular contractility [ 1 ]. Thyroxine (T4) and triiodothyronine (T3), which are secreted at a ratio of 20:1, respectively, are the two main forms of thyroid hormones.…”

Section: Introductionmentioning

confidence: 99%

Thyroid Storm Masquerading as Multiple Organ Dysfunction Syndrome: Catch Me if You Can

Khurana¹,

Kumar²,

Acharya³

et al. 2023

Cureus

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A 65-year-old man presented to the emergency medicine department with altered sensorium, a high-grade fever, and shock. On routine workup, he was diagnosed with acute respiratory distress syndrome with sepsis. Later, it was found that the patient had undetectable serum thyroid stimulating hormone and high triiodothyronine (T3) levels, which were diagnosed as a thyroid storm. This highlights the fact that a thyroid storm can present in any way and should be considered when determining the cause of septic shock that is not responding to standard treatment. A rare endocrine emergency, thyroid storm is a life-threatening endocrinological emergency with a considerable death rate of between 10% and 30% and multi-organ failure. It happens in thyrotoxic patients and manifests as the decompensation of several organs brought on by extreme stress. In addition to shock, the patient also had altered sensory perception, a cough, a fever, palpitations, and a sore throat. The patient was initially diagnosed with septic shock and was later treated with oral carbimazole, higher antibiotics, inotropes, and propranolol.

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Thyroid storm presenting as septic shock in the intensive care unit: A Case Series

Cited by 3 publications

References 7 publications

Impending tyroid storm

Impending tyroid storm

Anchoring on Hyperglycemia and Sepsis in the Presence of an Unforeseen Thyroid Storm

Thyroid Storm Masquerading as Multiple Organ Dysfunction Syndrome: Catch Me if You Can

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