101
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Creo AL, Cannon BC, Pittock ST. Thyroid storm after choking. J Pediatr Endocrinol Metab 2018; 31:933-936. [PMID: 29935115 DOI: 10.1515/jpem-2018-0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/01/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND A thyroid storm (TS) is a rare, but life-threatening condition in hyperthyroid patients. Mortality in adult TS patients may be as high as 10%. Typically, a trigger precipitates the storm in hyperthyroid patients. CASE PRESENTATION We report the case of an adolescent girl with untreated hyperthyroidism who developed fulminant TS after a significant choking episode. Initially, she was found to have neck swelling and tachycardia leading providers to suspect infection. She deteriorated after a CAT Scan (CT) was performed with iodine contrast, potentially worsening storm symptoms. Here, we describe the case, the treatment strategy and propose a treatment modification for pediatric patients. CONCLUSIONS While many children are found to have minor abnormalities in thyroid studies, this case highlights the critical importance of prompt medical attention for any child with significantly elevated free thyroxine (FT4) levels as morbidity can occur when left untreated.
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Affiliation(s)
- Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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Abstract
PURPOSE OF REVIEW This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities. RECENT FINDINGS To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. A 2015 prospective study in patients with adrenal insufficiency found a significant number of adrenal crisis-related deaths despite all study patients receiving standard care and being educated on crisis prevention strategies, highlighting that current prevention strategies and medical management remain suboptimal. SUMMARY Early diagnosis and prompt treatment of endocrine emergencies are essential but remain challenging because of a lack of objective diagnostic tools. The optimal management is also unclear as prospective and randomized studies are lacking. Additional research is needed for these clinical syndromes that can be fatal despite intensive medical intervention.
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103
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Rastogi V, Singh D, Mazza JJ, Parajuli D, Yale SH. Flushing Disorders Associated with Gastrointestinal Symptoms: Part 2, Systemic Miscellaneous Conditions. Clin Med Res 2018; 16:29-36. [PMID: 29650526 PMCID: PMC6108508 DOI: 10.3121/cmr.2017.1379b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
Flushing disorders with involvement of the gastrointestinal tract represent a heterogeneous group of conditions. In part 1 of this review series, neuroendocrine tumors (NET), mast cell activation disorders (MCAD), and hyperbasophilia were discussed. In this section we discuss the remaining flushing disorders which primarily or secondarily involve the gastrointestinal tract. This includes dumping syndrome, mesenteric traction syndrome, rosacea, hyperthyroidism and thyroid storm, anaphylaxis, panic disorders, paroxysmal extreme pain disorder, and food, alcohol and medications. With the exception of paroxysmal pain disorders, panic disorders and some medications, these disorders presents with dry flushing. A detailed and comprehensive family, social, medical and surgical history, as well as recognizing the presence of other systemic symptoms are important in distinguishing the different disease that cause flushing with gastrointestinal symptoms.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida College of Medicine/HCA, Consortium Graduate Medical Education, North Florida, Regional Medical Center, 6500 W Newberry Rd, Gainesville, FL 32605
- University of Central Florida College of Medicine, 6850, Lake Nona Blvd, Orlando, FL 32827
| | - Devina Singh
- Feinstein Institute for Medical Research, 350 Community, Dr. Manhasset, NY 11030
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, 1000 North Oak, Avenue, Marshfield, WI 54449
| | - Dipendra Parajuli
- University of Louisville, Department of Medicine, Gastroenterology, Hepatology and Nutrition. Director, Fellowship Training Program, Director, Medical Procedure Unit Louisville VAMC 401 East Chestnut Street, Louisville, KY 40202
| | - Steven H Yale
- University of Central Florida College of Medicine/HCA, Consortium Graduate Medical Education, North Florida, Regional Medical Center, 6500 W Newberry Rd, Gainesville, FL 32605.
- University of Central Florida College of Medicine, 6850, Lake Nona Blvd, Orlando, FL 32827
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104
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Al Jassim A, Wallace T, Bouhabel S, Majdan A, Hier M, Forest VI, Payne R. A retrospective cohort study: do patients with graves' disease need to be euthyroid prior to surgery? J Otolaryngol Head Neck Surg 2018; 47:37. [PMID: 29784035 PMCID: PMC5963139 DOI: 10.1186/s40463-018-0281-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background The 2016 American Thyroid Association guidelines indicate that patients with Graves’ disease who undergo a thyroidectomy should be rendered euthyroid through the use of antithyroid drugs (ATD) prior to surgery to avoid complications such as a thyroid storm. At times, the use of ATDs can have limited efficacy and therefore some patients will inevitably remain biochemically hyperthyroid at the time of surgery. The aim of this study is to assess if hyperthyroid patients undergoing a thyroidectomy are at an increased risk of developing a thyroid storm in comparison to euthyroid patients. Furthermore, this study seeks to establish a correlation between thyroid storm identified by the levels of thyroid hormones (T3 and T4) and the level of thyroid stimulating hormone (TSH). Methods A retrospective cohort study was conducted at two Canadian centers, one in Montreal and the other in Nova Scotia. Sixty-seven patients undergoing thyroidectomy for Graves’ disease from January 2006 to December 2016 were evaluated. Results The study comprised 67 participants with a mean age of 46 years (range16–78 years). A total of 78% of patients were on methimazole, 34% on beta-blockers, 27% on potassium iodine solution, 10% on propylthiouracil and 7% on steroids. At the time of surgery 21% were in an overt hyperthyroid state and 33% were in a subclinical hyperthyroid state. The average TSH level of 0.03 mIUL/L (range 0.01–0.23 mIUL/L). Sixteen percent of patients had a TSH level less than 0.01 mIUL/L. The average free T4 level was 29.58 pmol/L (range 11.5–95.2 pmol/L). The average total T3 level was 11.52 nmol/L (range 4.5–29.1 nmol/L) and free T3 level was 6.35 pmol/L (range 6.1–6.6 pmol/L). No patient developed thyroid storm. Conclusions In our study, biochemically hyperthyroid patients undergoing thyroidectomy did not develop thyroid storm. Additional studies with larger sample sizes are needed to better understand the risk of thyroid storm in hyperthyroid patients.
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Affiliation(s)
- Abrar Al Jassim
- Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada.
| | - Tim Wallace
- Department of Otolaryngology - Head and Neck surgery, Cumberland Regional Health Care Center, Dalhousie University, Halifax, NS, Canada
| | - Sarah Bouhabel
- Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Agnieszka Majdan
- Division of Endocrinology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Richard Payne
- Department of Otolaryngology - Head and Neck surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
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105
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Bonfield A, Shenoy S. Thyrotoxic crisis as an acute clinical presentation in a child. BMJ Case Rep 2018; 2018:bcr-2017-222850. [DOI: 10.1136/bcr-2017-222850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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106
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Nai Q, Ansari M, Pak S, Tian Y, Amzad-Hossain M, Zhang Y, Lou Y, Sen S, Islam M. Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review. J Clin Med Res 2018; 10:351-357. [PMID: 29511425 PMCID: PMC5827921 DOI: 10.14740/jocmr3106w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
Thyroid storm is a potentially fatal manifestation of thyrotoxicosis. Cardiopulmonary failure is the most common cause of death in thyroid storm. Clinicians should keep in mind that thyroid storm complicated with cardiopulmonary failure can be the first presentation of thyrotoxicosis. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance in the management of thyrotoxicosis. A high index of suspicion and the ability of early recognition of impending thyroid storm depends on a thorough knowledge of both the typical and atypical clinical features of this illness. Herein, we report a case of thyroid storm presenting as cardiopulmonary failure in a 51-year-old woman with undiagnosed Grave’s disease. Additionally, we review the pathophysiology of cardiopulmonary failure associated with thyrotoxicosis and various treatment modalities for thyroid storm.
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Affiliation(s)
- Qiang Nai
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.,These authors contributed equally
| | - Mohammad Ansari
- Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA.,These authors contributed equally
| | - Stella Pak
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Yufei Tian
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Mohammed Amzad-Hossain
- Department of Nephrology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Yanhong Zhang
- Department of Pulmonary and Critical Care, Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA
| | - Yali Lou
- Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Shuvendu Sen
- Department of Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Mohammed Islam
- Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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107
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Davis S, Mcintyre R, Cribari C, Dunn J. Thyroid Storm Induced by Trauma: A Challenging Combination. Am Surg 2018. [DOI: 10.1177/000313481808400202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stephanie Davis
- Division of GI, Tumor, and Endocrine Surgery Department of Surgery University of Colorado Aurora, Colorado
| | - Robert Mcintyre
- Division of GI, Tumor, and Endocrine Surgery Department of Surgery University of Colorado Aurora, Colorado
| | - Chris Cribari
- Trauma–Acute Care Surgery Medical Center of the Rockies University of Colorado Health Loveland, Colorado
| | - Julie Dunn
- Trauma–Acute Care Surgery Medical Center of the Rockies University of Colorado Health Loveland, Colorado
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108
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Abubakar H, Singh V, Arora A, Alsunaid S. Propranolol-Induced Circulatory Collapse in a Patient With Thyroid Crisis and Underlying Thyrocardiac Disease: A Word of Caution. J Investig Med High Impact Case Rep 2018; 5:2324709617747903. [PMID: 29318163 PMCID: PMC5753961 DOI: 10.1177/2324709617747903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/10/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022] Open
Abstract
Thyrotoxic crisis or thyroid storm is a severe form of hyperthyroidism and a rare endocrinological emergency. The cornerstones of medical therapy in thyroid storm include decreasing the levels of circulating T3 in the blood as well as inhibiting the hormone's peripheral effects through β-adrenergic blockade. Propranolol is the preferred agent for β-blockade in hyperthyroidism and thyroid storm due to its additional effect of blocking the peripheral conversion of inactive T4 to active form T3. We report a typical clinical scenario where propranolol was administered in treatment of thyroid storm but an uncommon adverse outcome: circulatory failure from cardiogenic shock warranting vasopressor and inotropic support. Caution with regard to the use long-acting β-blocking agents in patients with underling thyrocardiac disease may prevent this life-threatening adverse effect. Ultra-short-acting β-blockers that are easy to titrate maybe a suitable alternative in this subset of patients.
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Affiliation(s)
- Hossam Abubakar
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Vijendra Singh
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Anandita Arora
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Sammar Alsunaid
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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109
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Sen S, Palmieri T, Greenhalgh D. Thyroid storm in a pediatric high voltage electrical burn injury. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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110
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A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis. Case Rep Cardiol 2018; 2018:4827907. [PMID: 29713551 PMCID: PMC5866855 DOI: 10.1155/2018/4827907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/03/2018] [Accepted: 02/06/2018] [Indexed: 01/01/2023] Open
Abstract
Severe thyrotoxicosis can present with a myriad of cardiovascular complications. It may be mild features such as palpitations, tachycardia, and exertional dyspnea or may progress to life-threatening consequences such as atrial fibrillation, tachyarrhythmias, heart failure, myocardial infarction, and shock. In rare cases, they may present with myocardial ischemia secondary to coronary artery vasospasm. We report a case of a 59-year-old Malay gentleman who presented with fast atrial fibrillation and tachycardia-mediated heart failure that evolved to a silent myocardial infarction secondary to severe coronary artery vasospasm with undiagnosed severe thyrotoxicosis. He had complete resolution of heart failure and no further recurrence of coronary artery vasospasm once treatment for thyrotoxicosis was initiated and euthyroidism achieved. This life-threatening consequence has an excellent prognosis if recognised early and treated promptly.
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111
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Aghajanzadeh M, Asgary MR, Mohammadi F, Darvishi H, Safarpour Y. An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter. J Family Med Prim Care 2018; 7:224-229. [PMID: 29915764 PMCID: PMC5958574 DOI: 10.4103/jfmpc.jfmpc_286_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients. Materials and Methods: Data related to demographic data (age and gender), clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT], chest X-ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis) were collected. Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45–60 years. Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%) was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia. Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively.
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Affiliation(s)
- Manouchehr Aghajanzadeh
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Mohammad Reza Asgary
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Fereshteh Mohammadi
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Haniye Darvishi
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Yasaman Safarpour
- Inflammatory Lung Disease Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
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112
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Brundridge W, Perkins J. Iodinated Contrast Administration Resulting in Cardiogenic Shock in Patient with Uncontrolled Graves Disease. J Emerg Med 2017; 53:e125-e128. [PMID: 29102101 DOI: 10.1016/j.jemermed.2017.08.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thyroid storm (also known as thyroid or thyrotoxic crisis) is part of the spectrum of thyrotoxicosis and represents the extreme end of that spectrum. The condition is quite rare, yet mortality rates are high and may approach 10-30%. CASE REPORT A 34-year-old-man who had a history of Graves disease presented in atrial fibrillation with rapid ventricular response and mild congestive heart failure. During the course of his Emergency Department (ED) stay he deteriorated into cardiogenic shock. Roughly 10 h transpired between his presentation and the development of cardiogenic shock. He had received an intravenous contrast load of iohexol shortly after initial presentation, and the associated iodine bolus, we suspect, contributed to his abrupt deterioration into cardiogenic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Thyroid storm is infrequently seen in the ED, and there is potential for management errors that can lead to a detrimental patient outcome.
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Affiliation(s)
- Wes Brundridge
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas
| | - Jack Perkins
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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113
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Godo S, Kawazoe Y, Ozaki H, Fujita M, Kudo D, Nomura R, Shimokawa H, Kushimoto S. Switching Therapy from Intravenous Landiolol to Transdermal Bisoprolol in a Patient with Thyroid Storm Complicated by Decompensated Heart Failure and Gastrointestinal Dysfunction. Intern Med 2017; 56:2603-2609. [PMID: 28883252 PMCID: PMC5658526 DOI: 10.2169/internalmedicine.8846-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.
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Affiliation(s)
- Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
| | - Yu Kawazoe
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
| | - Hiroshi Ozaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Motoo Fujita
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Ryosuke Nomura
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan
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114
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Monteiro AM, Matta-Coelho C, Fernandes V, Marques O. Type 2 Diabetes Decompensation as the Clinical Presentation of Thyroid Storm - Cause or Consequence? EUROPEAN ENDOCRINOLOGY 2017; 13:99-101. [PMID: 29632616 PMCID: PMC5813473 DOI: 10.17925/ee.2017.13.02.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022]
Abstract
This case study aims to discuss the unusual forms of hyperthyroidism presentation, the nonspecific symptoms and precipitating events. A 70-year-old male was taken to the emergency department for hyperglycaemia, nausea, vomiting and altered mental status with a week of evolution. He had a past medical history of type 2 diabetes, hypertension and dyslipidemia. He had no history of any recent intercurrent illness or infection. At the emergency room, besides hyperglycaemia, ketonemia and slightly elevated C-reactive protein, the basic laboratory panel workup was normal, as was the head computed tomography. He was admitted for metabolic compensation and to study the altered neurological status. During hospitalisation, despite the good glycemic control, he had no improvements in neurological status. At day four of hospitalisation, thyrotoxicosis with thyroid storm criteria was diagnosed. He started on adequate treatment with complete clinical recovery. The associated morbidity and mortality of thyroid storm requires immediate recognition and treatment. Elderly patients are frequently misdiagnosed or diagnosed later due to fewer and less pronounced signs and symptoms.
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Affiliation(s)
| | | | - Vera Fernandes
- Endocrinology Department, Hospital de Braga, Braga, Portugal
| | - Olinda Marques
- Endocrinology Department, Hospital de Braga, Braga, Portugal
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115
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McGonigle AM, Tobian AAR, Zink JL, King KE. Perfect storm: Therapeutic plasma exchange for a patient with thyroid storm. J Clin Apher 2017; 33:113-116. [PMID: 28608527 DOI: 10.1002/jca.21560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 11/07/2022]
Abstract
Thyroid storm is a potentially lethal complication of hyperthyroidism with increased thyroid hormones and exaggerated symptoms of thyrotoxicosis. First-line therapy includes methimazole (MMI) or propylthiouracil (PTU) to block production of thyroid hormones as a bridge toward definitive surgical treatment. Untreated thyroid storm has a mortality rate of up to 30%; this is particularly alarming when patients cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy. Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature. Yet TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines and cytokines and is likely beneficial for these patients. We report a patient with thyroid storm who could not tolerate PTU, subsequently failed therapy with MMI, and was not appropriate for thyroidectomy. TPE was therefore performed daily for 4 days (1.0 plasma volume with 5% albumin replacement and 2 U of plasma). Over the treatment course, the patient's thyroid hormones normalized and symptoms of thyroid storm largely resolved; his T3 decreased from 2.27 to 0.81 ng/mL (normal 0.8-2.0), T4 decreased from 4.8 to 1.7 ng/mL (0.8-1.8), heart rate normalized, altered mental status improved, and he converted to normal sinus rhythm. He was ultimately discharged in euthyroid state. He experienced no side effects from his TPE procedures. TPE is a safe and effective treatment for thyroid storm when conventional treatments are not successful or appropriate.
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Affiliation(s)
- Andrea M McGonigle
- Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Hemapheresis and Transfusion Support (HATS), Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Aaron A R Tobian
- Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Hemapheresis and Transfusion Support (HATS), Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jennifer L Zink
- Hemapheresis and Transfusion Support (HATS), Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Karen E King
- Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Hemapheresis and Transfusion Support (HATS), Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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116
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Mohananey D, Smilowitz N, Villablanca PA, Bhatia N, Agrawal S, Baruah A, Ali MS, Bangalore S, Ramakrishna H. Trends in the Incidence and In-Hospital Outcomes of Cardiogenic Shock Complicating Thyroid Storm. Am J Med Sci 2017; 354:159-164. [PMID: 28864374 DOI: 10.1016/j.amjms.2017.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/17/2017] [Accepted: 04/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thyroid storm (TS) constitutes an endocrine emergency with an incidence of up to 10% of all admissions for thyrotoxicosis. Cardiogenic shock (CS) is a rare complication of TS and very limited data exists on its incidence and outcomes. We aimed to estimate the national trends in incidence and outcomes of CS among patients admitted to US hospitals with TS. MATERIALS AND METHODS We queried the nationwide inpatient sample for patients with the discharge diagnosis of TS between the years of 2003 and 2011. RESULTS Based on a weighted estimate, we identified 41,835 patients with a diagnosis of TS, of which 1% developed CS. Patients with CS were more likely to have history of atrial fibrillation, alcohol abuse, preexisting congestive heart failure, coagulopathy, drug use, liver disease, pulmonary circulation disorders, valvular disorders, weight loss, renal failure, fluid and electrolyte disorders as compared to those who did not develop CS (P < 0.001 for all). We observed an increase in incidence of CS from 0.5% in 2003 to 3% in 2011 and a decrease in mortality from 60.5% in 2003 to 20.9% in 2011 (Ptrend < 0.001 for both). CONCLUSIONS We observed that CS is a rare complication of TS, which occurs more commonly in male patients with preexisting structural and atherosclerotic heart disease, and carries a very poor prognosis. Although incidence has increased over the years, mortality from CS has steadily declined.
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Affiliation(s)
| | - Nathaniel Smilowitz
- Division of Cardiology, New York University School of Medicine, New York, New York
| | - Pedro A Villablanca
- Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Nirmanmoh Bhatia
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sahil Agrawal
- Department of Cardiovascular Medicine, St. Lukes University Health Network, Bethlehem, Pennsylvania
| | - Anushka Baruah
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois
| | - Muhammad S Ali
- Division of Pulmonary, Critical Care & Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York
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117
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Shah KK, Mbughuni MM, Burgstaler EA, Block DR, Winters JL. Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange. J Clin Apher 2017; 32:579-583. [DOI: 10.1002/jca.21536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Kabeer K. Shah
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
- Mayo School of Graduate Medical Education; Mayo Clinic; Rochester Minnesota
| | - Michael M. Mbughuni
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
- Mayo School of Graduate Medical Education; Mayo Clinic; Rochester Minnesota
| | - Edwin A. Burgstaler
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Darci R. Block
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
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118
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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119
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Abstract
Autoimmune thyroid diseases (AIT) are common in children and may present with a variety of signs and symptoms including: euthyroid goiter, hypothyroidism, or hyperthyroidism. The natural history of AIT may be different in children but in all age groups, there appear to be genetic risk factors and environmental triggers that initiate thyroid autoimmunity. Areas covered: In this review, we summarize recent studies that investigate the genetics and environmental triggers believed to be involved in thyroid autoimmunity. We also discuss the approach and controversies in the treatment of children with AIT. Expert commentary: Much has been learned about the major roles for genetics, cytokines, regulatory lymphocytes, and environmental triggers in CLT but controversies remain.
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Affiliation(s)
- Prasanthi Pasala
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
| | - Gary L Francis
- a Pediatric Endocrinology and Metabolism, Department of Pediatrics , Children's Hospital of Richmond at Virginia Commonwealth University , Richmond , VA , USA
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120
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Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm. Case Rep Med 2017; 2017:9454698. [PMID: 28912821 PMCID: PMC5587932 DOI: 10.1155/2017/9454698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/09/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
A 26-year-old female, thirteen months postpartum, presented to the emergency department for four weeks of epigastric abdominal pain, pruritus, new onset jaundice, and 11.3 kgs (25 lbs) unintentional weight loss. On examination, she was afebrile, tachycardic, alert, and oriented and had jaundice with scleral icterus. Labs were significant for undetectable TSH, FT4 that was too high to measure, and elevated total bilirubin, direct bilirubin, alkaline phosphatase, and transaminases. Abdominal ultrasound revealed cholelithiasis without biliary ductal dilation. Treatment for presumed thyroid storm was initiated. Further work-up with magnetic resonance cholangiopancreatography (MRCP) revealed an obstructing cholelith within the distal common bile duct. With the presence of choledocholithiasis explaining the jaundice and abdominal pain, plus the absence of CNS alterations, the diagnosis of thyroid storm was revised to thyrotoxicosis complicated by choledocholithiasis. Endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy was performed to alleviate the biliary obstruction, with prompt symptomatic improvement. Thyroid storm is a rare manifestation of hyperthyroidism with a high rate of morbidity and mortality. The diagnosis of thyroid storm is based on clinical examination, and abnormal thyroid function tests do not correlate with disease severity. Knowledge of the many manifestations of thyroid storm will facilitate a quick and accurate diagnosis and treatment.
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121
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Long B, Koyfman A. Clinical Mimics: An Emergency Medicine–Focused Review of Sepsis Mimics. J Emerg Med 2017; 52:34-42. [DOI: 10.1016/j.jemermed.2016.07.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
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122
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Mathew GM, Rodriguez A, Lawrence L, Krishnasamy KP, Marok RS, Pauwaa S, Dia M, Macaluso GP, Drever ED, Yasmeen T. A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man. AACE Clin Case Rep 2017. [DOI: 10.4158/ep15911.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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123
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Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J 2016; 63:1025-1064. [PMID: 27746415 DOI: 10.1507/endocrj.ej16-0336] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan. Detailed analyses of clinical data from 356 patients revealed that the mortality in Japan was still high (∼11%) and that multiple organ failure and acute heart failure were common causes of death. In addition, multimodal treatment with antithyroid drugs, inorganic iodide, corticosteroids and beta-adrenergic antagonists has been suggested to improve mortality of these patients. Based on the evidence obtained by nationwide surveys and additional literature searches, we herein established clinical guidelines for the management of thyroid storm. The present guideline includes 15 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular system, and hepato-gastrointestinal tract, admission criteria for the intensive care unit, and prognostic evaluation. We also proposed preventive approaches to thyroid storm, roles of definitive therapy, and future prospective trial plans for the treatment of thyroid storm. We hope that this guideline will be useful for many physicians all over the world as well as in Japan in the management of thyroid storm and the improvement of its outcome.
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Affiliation(s)
- Tetsurou Satoh
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
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125
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Wang HI, Yiang GT, Hsu CW, Wang JC, Lee CH, Chen YL. Thyroid Storm in a Patient with Trauma - A Challenging Diagnosis for the Emergency Physician: Case Report and Literature Review. J Emerg Med 2016; 52:292-298. [PMID: 27742400 DOI: 10.1016/j.jemermed.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thyroid storm, an endocrine emergency, remains a diagnostic and therapeutic challenge. It is recognized to develop as a result of several factors, including infection, surgery, acute illness, and rarely, trauma. Recognition of thyroid storm in a trauma patient is difficult because the emergency physician usually focuses on managing more obvious injuries. OBJECTIVE OF THE REVIEW We present a case of trauma-related thyroid storm and review the previous literature on posttraumatic thyroid storm to delineate risk factors of the disease. The case occurred in a 32-year-old man after a motorcycle accident. DISCUSSION Careful investigation of patient history and risk factors of trauma-related thyroid storms and utilization of the scoring system may facilitate early diagnosis. Traumatically induced thyroid storm usually responds to medical treatment developed for hyperthyroidism. Surgical intervention may be needed for patients who failed medical treatment or those with direct thyroid gland injuries. The outcome is usually fair under appropriate management. CONCLUSION We present a case of trauma-related thyroid storm to illustrate the diagnostic and therapeutic approach with a summary of the previous literature. Emergency physicians should be aware of the clinical presentation and risk factors of patients with trauma-related thyroid storm to reduce the rate of misdiagnosis and prevent catastrophic outcomes.
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Affiliation(s)
- Hsiang-I Wang
- Department of Emergency Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hsing Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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126
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Chantra M, Limsuwan A, Mahachoklertwattana P. Low cardiac output thyroid storm in a girl with Graves' disease. Pediatr Int 2016; 58:1080-1083. [PMID: 27804243 DOI: 10.1111/ped.13102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/31/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
A 15-year-old girl with Graves' disease presented with hypotension after methimazole and propranolol were re-started for hyperthyroidism. She was found to have pulmonary artery hypertension resulting in obstructive shock. Thyroid storm was diagnosed according to Burch and Wartofsky score. She was promptly treated with anti-thyroid drugs, inorganic iodide, corticosteroid, and respiratory support. Pulmonary hypertension was treated with inhaled nitric oxide until the clinical status improved. Propranolol was withdrawn due to poor cardiac function. We herein present a unique case of a difficult-to-treat Graves' disease presenting with severe pulmonary hypertension resulting in low cardiac output thyroid storm.
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Affiliation(s)
- Marut Chantra
- Division of Critical Care Medicine, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Alisa Limsuwan
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pat Mahachoklertwattana
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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127
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Abstract
Myxedema coma and thyroid storm are thyroid emergencies associated with increased mortality. Prompt recognition of these states-which represent the severe, life-threatening conditions of extremely reduced or elevated circulating thyroid hormone concentrations, respectively-is necessary to initiate treatment. Management of myxedema coma and thyroid storm requires both medical and supportive therapies and should be treated in an intensive care unit setting.
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128
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Sharp CS, Wilson MP, Nordstrom K. Psychiatric Emergencies for Clinicians: The Emergency Department Management of Thyroid Storm. J Emerg Med 2016; 51:155-8. [DOI: 10.1016/j.jemermed.2016.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/19/2015] [Accepted: 01/22/2016] [Indexed: 10/21/2022]
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129
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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130
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Misumi K, Kodera S, Nagura F, Kushida S, Shiojiri T, Kanda J. Cardiac arrest caused by landiolol in a patient in thyroid crisis. J Cardiol Cases 2016; 14:62-64. [PMID: 30546666 DOI: 10.1016/j.jccase.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
Abstract
In the acute phase of a thyroid crisis, the cardiovascular mortality rate is high and the likelihood of death and severity of heart failure increase significantly with an increasing heart rate. Thus, heart rate control is essential to avoid cardiac death. Propranolol has been used to manage thyroid crisis, but worsening heart failure and cardiac arrest have been previously reported when using propranolol in such cases. Thus, short-acting beta-blockers, such as landiolol and esmolol, are recommended, especially in patients with a low ejection fraction and severe heart failure. Our patient was a 49-year-old woman with a medical history of Graves' disease, who stopped attending her control visits 1 year earlier. She presented with symptoms of heart failure, atrial fibrillation, and tachycardia. She was diagnosed with thyroid storm and low-ejection-fraction heart failure. After 2.5 h of treatment with landiolol, her heart suddenly arrested. Cardiopulmonary resuscitation was performed immediately and circulation was re-established. After receiving treatment for the thyroid crisis and heart failure, she was discharged without any sequelae. To the best of our knowledge, cardiac collapse caused by landiolol has not been previously reported. We wish to emphasize the importance of close hemodynamic monitoring when using landiolol in such cases. <Learning objective: Short-acting beta-blockers, such as landiolol, are used to treat thyroid crises. These agents are recommended because dose regulation is easy due to their short action and beta-1 selectivity. Our patient developed cardiac arrest when we attempted to treat the thyroid crisis with landiolol. This case suggests that landiolol might lead to cardiac arrest when used to treat patients in thyroid crisis who present with a concomitant hepatic disorder and low-ejection-fraction heart failure.>.
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Affiliation(s)
- Kayo Misumi
- Department of Cardiology, Asahi General Hospital, Chiba, Japan
| | - Satoshi Kodera
- Department of Cardiology, Asahi General Hospital, Chiba, Japan
| | - Fukuko Nagura
- Department of Cardiology, Asahi General Hospital, Chiba, Japan
| | | | - Toshiaki Shiojiri
- Department of General Medicine, Asahi General Hospital, Chiba, Japan
| | - Junji Kanda
- Department of Cardiology, Asahi General Hospital, Chiba, Japan
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131
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Beynon ME, Pinneri K. An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist. Acad Forensic Pathol 2016; 6:217-236. [PMID: 31239894 DOI: 10.23907/2016.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/31/2016] [Accepted: 04/25/2016] [Indexed: 01/08/2023]
Abstract
The thyroid gland is a butterfly-shaped organ situated in the anterior neck whose functions have system-wide effects. Thyroid diseases represent some of the most commonly encountered endocrine disorders and therefore are commonly encountered at the time of autopsy. Knowing how the gland functions and the effects it may have on vital organs is important when determining the cause of death and significant contributory conditions. Endocrine-related deaths may be anatomically subtle, therefore histologic examination, review of medical records, and selected postmortem testing must be performed to correctly identify and document their presence. For this reason, it is recommended that pathologists consider regularly examining the thyroid gland histologically, particularly on decedents where no apparent anatomic cause of death is identified after the autopsy. This article provides an in-depth review of the thyroid gland, thyroid hormones, and thyroid diseases, including potential thyroid-related deaths and incidental autopsy findings.
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133
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Nakabayashi K, Nakazawa N, Suzuki T, Asano R, Saito H, Nomura H, Isomura D, Okada H, Sugiura R, Oka T. Thyroid Echography-induced Thyroid Storm and Exacerbation of Acute Heart Failure. Intern Med 2016; 55:2209-12. [PMID: 27522996 DOI: 10.2169/internalmedicine.55.6862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hyperthyroidism and thyroid storm affect cardiac circulation in some conditions. Several factors including trauma can induce thyroid storms. We herein describe the case of a 57-year-old woman who experienced a thyroid storm and exacerbation of acute heart failure on thyroid echography. She initially demonstrated a good clinical course after medical rate control for atrial fibrillation; however, thyroid echography for evaluating hyperthyroidism led to a thyroid storm and she collapsed. A multidisciplinary approach stabilized her thyroid hormone levels and hemodynamics. Thus, the medical staff should be prepared for a deterioration in the patient's condition during thyroid echography in heart failure patients with hyperthyroidism.
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134
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Naqvi SY, Luebbert JJ, Rosen SG. Thyroid storm in a patient with Wolff-Parkinson-White syndrome. BMJ Case Rep 2015; 2015:bcr2015212569. [PMID: 26670895 PMCID: PMC4680325 DOI: 10.1136/bcr-2015-212569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/04/2022] Open
Abstract
A 44-year-old woman with no medical history presented to the emergency department with a 2 h history of sudden onset chest pressure, palpitations, diaphoresis and shortness of breath. She reported a 90-pound unintentional weight loss, increased appetite, irritability, night sweats and palpitations for 2 months. Physical examination revealed a heart rate (HR) of 269 bpm and a blood pressure of 116/94 mm Hg. Her ECG revealed a wide-complex tachycardia with right bundle branch morphology and an HR of 265 bpm. Intravenous adenosine was administered with resolution of the arrhythmia and symptoms. Her subsequent ECG revealed sinus tachycardia with δ waves, which was consistent with Wolff-Parkinson-White (WPW) syndrome. Laboratory findings confirmed thyroid storm and treatment began with intravenous hydrocortisone, methimazole, metoprolol, amiodarone and iodine drops. Graves' disease was confirmed based on the presence of serum thyroid-stimulating hormone receptor antibody. The patient underwent successful WPW accessory tract ablation 6 weeks after initial presentation.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey J Luebbert
- Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen G Rosen
- Department of Endocrinology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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135
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Traveling Guides for Patients Suffering from Thyroid Disorders. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2015. [DOI: 10.20286/ijtmgh-0304146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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136
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Yildar M, Demirpolat G, Aydin M. Acute suppurative thyroiditis accompanied by thyrotoxicosis after fine-needle aspiration: treatment with catheter drainage. J Clin Diagn Res 2015; 8:ND12-4. [PMID: 25584265 DOI: 10.7860/jcdr/2014/9550.5186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
Abstract
Fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of thyroid diseases. Serious complications are rare and this procedure is generally safe. Acute supurative thyroiditis (AST) after FNA has been seldomly reported. We report a case of a 57-year-old women with diabetes mellitus who developed AST with thyrotoxicosis after FNA. She was successfully treated by sonographically guided percutaneous drainage and antithyroid agent.
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Affiliation(s)
- Murat Yildar
- Faculty of Medicine, Department of General Surgery, Balıkesir University , Balıkesir, Turkey
| | - Gulen Demirpolat
- Faculty of Medicine, Department of Radiology, Balıkesir University , Balıkesir, Turkey
| | - Mehtap Aydin
- Faculty of Medicine, Department of Infectious Diseases, Balıkesir University , Balıkesir, Turkey
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137
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Lacy ME, Utzschneider KM. Cocaine Intoxication and Thyroid Storm: Similarity in Presentation and Implications for Treatment. J Investig Med High Impact Case Rep 2014; 2:2324709614554836. [PMID: 26425625 PMCID: PMC4528882 DOI: 10.1177/2324709614554836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction. Cocaine, a widely used sympathomimetic drug, causes thermoregulatory and cardiac manifestations that can mimic a life-threatening thyroid storm. Case. A man presented to the emergency department requesting only cocaine detoxification. He reported symptoms over the last few years including weight loss and diarrhea, which he attributed to ongoing cocaine use. On presentation he had an elevated temperature of 39.4°C and a heart rate up to 130 beats per minute. Examination revealed the presence of an enlarged, nontender goiter with bilateral continuous bruits. He was found to have thyrotoxicosis by labs and was treated for thyroid storm and cocaine intoxication concurrently. The patient was ultimately diagnosed with Graves’ disease and treated with iodine-131 therapy. Conclusion. Cocaine use should be considered a possible trigger for thyroid storm. Recognition of thyroid storm is critical because of the necessity for targeted therapy and the significant mortality associated with the condition if left untreated.
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Affiliation(s)
| | - Kristina M Utzschneider
- University of Washington, Seattle, WA, USA ; VA Puget Sound Health Care System, Seattle, WA, USA
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138
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Weinstock RJ, Lewis T, Miller J, Clarkson EI. Thyroid crisis in the maxillofacial trauma patient. J Oral Maxillofac Surg 2014; 72:2148.e1-7. [PMID: 25085805 DOI: 10.1016/j.joms.2014.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/04/2014] [Accepted: 04/21/2014] [Indexed: 11/15/2022]
Abstract
Thyroid crisis, also known as thyroid storm, is a rare complication of thyrotoxicosis that results in a hypermetabolic and hyperadrenergic state. This condition requires prompt recognition and treatment because the mortality from thyroid crisis approaches 30%. Thyrotoxicosis alone will usually not progress to thyroid crisis. Thyroid crisis will typically be precipitated by some concomitant event such as infection, iodine-containing contrast agents, medications such as amiodarone, pregnancy, or surgery. Trauma is a rare precipitator of thyroid crisis. Several published studies have reported thyroid crisis resulting from blunt or penetrating neck trauma. Significant systemic trauma, such as motor vehicle accidents, has also been reported to precipitate thyroid crisis. It is very unusual for minor trauma to precipitate thyroid crisis. In the present study, we report the case of a patient who had incurred relatively minor maxillofacial trauma and developed thyroid crisis 2 weeks after the initial trauma.
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Affiliation(s)
- Robert J Weinstock
- Resident, Department of Oral and Maxillofacial Surgery, Woodhull Medical and Mental Health Center, Brooklyn, NY.
| | - Tashorn Lewis
- Resident, Department of Oral and Maxillofacial Surgery, Woodhull Medical and Mental Health Center, Brooklyn, NY
| | - Jared Miller
- Resident, Department of Oral and Maxillofacial Surgery, Woodhull Medical and Mental Health Center, Brooklyn, NY
| | - Earl I Clarkson
- Director, Department of Dentistry/Oral and Maxillofacial Surgery, The Brooklyn Hospital Center; and Chief and Program Director, Department of Oral and Maxillofacial Surgery, Woodhull Medical and Mental Health Center, Brooklyn, NY
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