Thyroid Storm with Multiple Organ Failure, Disseminated Intravascular Coagulation, and Stroke with a Normal Serum FT3 Level

Harada, Yasuhiro; Akiyama, Hisanao; Yoshimoto, Tatsuji; Urao, Yasuko; Ryuzaki, Munekazu; Handa, Michiko

doi:10.2169/internalmedicine.51.7974

Cited by 9 publications

(15 citation statements)

References 13 publications

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“…Therefore, the diagnosis of concomitant or unrelated liver disease is difficult until hyperthyroidism has been controlled. Although serum bilirubin levels in the present case steadily increased despite improvements in heart failure symptoms and cardiac function, serum bilirubin levels gradually decreased with reductions in thyroid hormone levels, which is consistent with previously reported cases [12][13][14][15]. Collectively, our results implicated thyroid crisis due to Graves' disease as the cause of severe jaundice in this case.…”

Section: Discussionsupporting

confidence: 92%

A Case of Thyroid Crisis With Worsening Jaundice Despite Improvements in Heart Failure

et al. 2016

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We herein present a case of a 33-year-old woman who was referred to our hospital for dyspnea on effort 2 months before her admission. Although diffuse enlargement of the thyroid gland occurred at the age of 23, she did not undergo detailed medical examinations. She was diagnosed with hyperthyroidism due to Graves' disease, and the administration of methimazole was initiated at a dosage of 30 mg/day. She had congestive heart failure, rapid atrial fibrillation, and disseminated intravascular coagulation on admission. Thyroid crisis was diagnosed based on the diagnostic criteria of the Japan Endocrine Society (second edition). Although cardiac function and heart failure symptoms improved, her total bilirubin level continued to increase and peaked at 28.8 mg/dL. Her bilirubin level was reduced by anti-thyroid drugs and eventually normalized in parallel with improvements in thyroid function. Jaundice may have occurred as a secondary consequence of cholestasis due to hyperthyroidism because other causes such as drug-induced or autoimmune liver dysfunction were ruled out. We herein report a rare case of thyroid crisis with worsening jaundice despite improvements in heart failure. This case demonstrated that obtaining a detailed medical history and a careful examination of the clinical course were useful for reaching the differential diagnosis of severe jaundice and achieving steady improvements in this serious medical condition.

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Section: Discussionsupporting

confidence: 92%

A Case of Thyroid Crisis With Worsening Jaundice Despite Improvements in Heart Failure

et al. 2016

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“…Despite this, the patient developed a thyroid storm;, it is not uncommon to find reports of thyroid storm in a patient with normal thyroid hormone levels. [ 4 ] Altered tolerance of the nervous system to thyronines or an alteration in the catecholamine/thyroxine relationship is the probable explanation for the occurrence of thyroid storm in such cases.…”

Section: Discussionmentioning

confidence: 99%

Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy

et al. 2015

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Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.

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“…It is of utmost importance to be aware that the serum-free T3 and T4 concentrations may lie within their respective normal range in thyroid storm, which risks delay in commencing prompt treatment and risking poor outcome [10,11]. Generally, the Thyroid Storm Scoring System proposed by Burch and Wartofsky is used to make the diagnosis [8].…”

Section: Discussionmentioning

confidence: 99%

“…Although there has been a report of DIC complicating multiple organ failure caused by congestive heart failure in a thyroid storm, this complication is very rare [10]. Infection, surgical intervention, or trauma may cause thyroid storm, which can also induce DIC.…”

Section: Discussionmentioning

confidence: 99%

Thyroid storm complicated by bicytopenia and disseminated intravascular coagulation

et al. 2014

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Patient: Male, 23Final Diagnosis: Thyroid stormSymptoms: Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight lossMedication: —Clinical Procedure: —Specialty: Endocrinology and MetabolicObjective:Unusual clinical courseBackground:The clinical presentation of thyroid storm includes fever, tachycardia, hypertension, and neurological abnormalities. It is a serious condition with a high mortality rate. Furthermore, some other complications affect the clinical course of thyroid storm. Although it is reported that prognosis is poor when thyroid storm is complicated by disseminated intravascular coagulation syndrome (DIC) and leukopenia, reports of such cases are rare.Case Report:A 23-year-old man presented with delirium, high pyrexia, diarrhea, and weight loss of 18 kg over 2 months. According to the criteria of Burch and Wartofsky, he was diagnosed with thyroid storm on the basis of his symptom-complex and laboratory data that confirmed the presence of hyperthyroidism. Investigations also found leukopenia, thrombocytopenia, and disseminated intravascular coagulation, all of which are very rare complications of thyroid storm. We successfully treated him with combined therapy including anti-thyroid medication, despite leukopenia.Conclusions:Early diagnosis and treatment are essential in ensuring a good outcome for patients with this rare combination of medical problems.

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Thyroid Storm with Multiple Organ Failure, Disseminated Intravascular Coagulation, and Stroke with a Normal Serum FT3 Level

Cited by 9 publications

References 13 publications

A Case of Thyroid Crisis With Worsening Jaundice Despite Improvements in Heart Failure

A Case of Thyroid Crisis With Worsening Jaundice Despite Improvements in Heart Failure

Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy

Thyroid storm complicated by bicytopenia and disseminated intravascular coagulation

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