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Rácz K, Simon G, Kurucz A, Harsányi GT, Török M, Herczeg LT, Gergely PA. Case Report: A Sudden Thyroid-Related Death of a 15-Year-Old Girl. Diagnostics (Basel) 2024; 14:905. [PMID: 38732319 PMCID: PMC11083324 DOI: 10.3390/diagnostics14090905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
A 15-year-old young girl was found dead at home. There were no indications of any intervention or the application of force. On the previous day, she was admitted to hospital because of palpitations, fatigue, a headache, and a swollen neck. During a physical examination, a swollen thyroid gland and tachycardia were found. In the family history, her mother had thyroid disease. According to the laboratory values, she had elevated thyroid hormone levels. After administration of beta-blockers, the patient was discharged and died at home during the night. The parents denounced the hospital for medical malpractice; therefore, a Forensic Autopsy was performed. Based on the available clinical data, the autopsy, histological and toxicological results, the cause of death was stated as multiorgan failure due to disseminated intravascular coagulation (DIC) caused by the autoimmune Graves disease. The forensic assessment of the case does not reveal medical malpractice. Post-mortem diagnoses of thyroid disorders in cases of sudden death can be challenging. However, as the reported case illustrates, the diagnosis could be established after a detailed evaluation of antemortem clinical data, autopsy results, histology, and a toxicological examination.
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Affiliation(s)
- Kálmán Rácz
- Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary; (K.R.); (L.T.H.); (P.A.G.)
| | - Gábor Simon
- Medical School, Department of Forensic Medicine, University of Pécs, 7624 Pécs, Hungary
| | - Andrea Kurucz
- Clinical Center, Department of Cardiology and Cardiac Surgery, University of Debrecen, 4032 Debrecen, Hungary;
| | - Gergő Tamás Harsányi
- Pathology Department, Szabolcs-Szatmár-Bereg County Teaching Hospital, 4400 Nyíregyháza, Hungary;
| | - Miklós Török
- Clinical Center, Department of Pathology, Kenézy Gyula Campus, University of Debrecen, 4032 Debrecen, Hungary;
| | - László Tamás Herczeg
- Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary; (K.R.); (L.T.H.); (P.A.G.)
| | - Péter Attila Gergely
- Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary; (K.R.); (L.T.H.); (P.A.G.)
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Farooqi S, Raj S, Koyfman A, Long B. High risk and low prevalence diseases: Thyroid storm. Am J Emerg Med 2023; 69:127-135. [PMID: 37104908 DOI: 10.1016/j.ajem.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Thyroid storm is a rare but serious condition that carries a high rate of morbidity and even mortality. OBJECTIVE This review highlights the pearls and pitfalls of thyroid storm, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Thyroid storm is a challenging condition to diagnose and manage in the ED. It is characterized by exaggerated signs and symptoms of thyrotoxicosis and evidence of multiorgan decompensation, usually occurring in the presence of an inciting trigger. Clinical features of thyroid storm may include fever, tachycardia, signs of congestive heart failure, vomiting/diarrhea, hepatic dysfunction, and central nervous system disturbance. There are several mimics including sympathomimetic overdose, substance use disorders, alcohol withdrawal, acute pulmonary edema, aortic dissection, heat stroke, serotonin syndrome, and sepsis/septic shock. Ultimately, the key to diagnosis is considering the disease. While laboratory assessment can assist, there is no single laboratory value that will establish a diagnosis of thyroid storm. Clinical criteria include the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria. ED treatment focuses on diagnosing and managing the trigger; resuscitation; administration of steroids, thionamides, iodine, and cholestyramine; and treatment of hyperthermia and agitation. Beta blockers should be administered in the absence of severe heart failure. The emergency clinician should be prepared for rapid clinical deterioration and employ a multidisciplinary approach to treatment that involves critical care and endocrinology specialists. CONCLUSIONS An understanding of thyroid storm can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Samia Farooqi
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Sonika Raj
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Salih AM, Kakamad FH, Rawezh QS, Masrur SA, Shvan HM, Hawbash MR, Lhun TH. Subacute thyroiditis causing thyrotoxic crisis; a case report with literature review. Int J Surg Case Rep 2017; 33:112-114. [PMID: 28399492 PMCID: PMC5387892 DOI: 10.1016/j.ijscr.2017.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Subacute thyroiditis is a self-limited, inflammatory viral thyroid disease which presents with neck pain, usually accompanied by systemic symptoms. On the other hand, thyroid storm is a clinical condition of severe sudden hyperthyroidism accompanied by physiologic de-compensation. We presented a 29-year-old male with features of subacute thyroiditis and thyroid storm who is the third reported case managed by steroid, beta-blocker and analgesics. CONCLUSION subacute thyroiditis may present with thyrotoxic crisis which respond dramatically to corticosteroid therapy.
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Affiliation(s)
- Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, François Mitterrand Street, Sulaimani, Kurdistan Region, Iraq
| | - F H Kakamad
- Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, François Mitterrand Street, Sulaimani, Kurdistan Region, Iraq.
| | - Q S Rawezh
- Faculty of Science & Science Education, School of Science, Biology Department, University of Sulaimani, Raperin Street, Sulaimani, Kurdistan Region, Iraq; Bioscience Center, Goran Street, Sulaimani, Kurdistan Region, Iraq
| | - S A Masrur
- Bioscience Center, Goran Street, Sulaimani, Kurdistan Region, Iraq; Daik Laboratory, Goran Street, Sulaimani, Kurdistan Region, Iraq
| | - H M Shvan
- Faculty of Science & Science Education, School of Science, Biology Department, University of Sulaimani, Raperin Street, Sulaimani, Kurdistan Region, Iraq; Bioscience Center, Goran Street, Sulaimani, Kurdistan Region, Iraq
| | - M R Hawbash
- Bioscience Center, Goran Street, Sulaimani, Kurdistan Region, Iraq; Faculty of Science & Science Education, School of Science Education, Biology Department, University of Sulaimani,Francois Mitterrand Street, Sulaimani, Kurdistan Region, Iraq
| | - T H Lhun
- Bioscience Center, Goran Street, Sulaimani, Kurdistan Region, Iraq; Faculty of Science and Health, Clinical Psychology Department, Koya University, Danyal Mitran Street, Koya, Kurdistan Region, Iraq
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Abstract
Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should be initiated promptly targeting all steps of thyroid hormone formation, release, and action. Patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality of thyroid storm is currently reported at 10%. Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition.
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Affiliation(s)
- Maguy Chiha
- Division of Endocrinology and Metabolism, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Shanika Samarasinghe
- Division of Endocrinology and Metabolism, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Adam S. Kabaker
- Section of Endocrine Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
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Abstract
Thyroid storm is a rare but potentially fatal condition that is most frequently associated with Graves' disease. We present the case of a young woman who presented in thyroid storm, later diagnosed as being due to severe subacute thyroiditis. We discuss the diagnostic approach to thyroid storm, the initial management, and eventual treatment and course of subacute thyroiditis. This case illustrates the necessity to include subacute thyroiditis in the differential diagnosis of severe thyrotoxicosis and thyroid storm.
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Affiliation(s)
- Joanna L Swinburne
- Division of Endocrinology, St. Paul,s Hospital, University of British Columbia,Vancouver, British Columbia, Canada
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Reilly Lukela J, Mangrulkar RS, Tierney LM, DelValle J, Saint S. A midlife crisis. J Hosp Med 2006; 1:200-4. [PMID: 17219494 DOI: 10.1002/jhm.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jennifer Reilly Lukela
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48108, USA.
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Abstract
We present a case of thyroid storm manifesting as supraventricular tachycardia with cardiopulmonary dysfunction. Our patient presented with severe cardiopulmonary symptoms (tachycardia, respiratory distress, and pulmonary edema) refractory to standard medical treatment. When the diagnosis of thyroid storm was made and proper treatment initiated, our patient had a prompt and appropriate response.
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Affiliation(s)
- David A Wald
- Department of Emergency Medicine, Temple University Hospital, Jones Hall 10th Floor, Ontario Street & Park Avenue, Philadelphia, PA 19140, USA
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Abstract
Excluding a source of hemorrhage after blunt trauma in a patient who presents with a sustained tachycardia can be challenging. This report is of two trauma patients presenting with undiagnosed thyrotoxicosis. Trauma-triggered thyrotoxicosis is rarely reported in the literature. The confusing presentation, the laboratory analysis, and the response to therapeutic intervention are reviewed.
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Affiliation(s)
- V Davis
- Division of Emergency Medicine, University of Arizona College of Medicine, Tucson, USA
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Affiliation(s)
- A M Choudhary
- Department of Medicine, Bridgeport Hospital/Yale University School of Medicine, CT, USA.
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Abstract
A 21-year-old woman presented to the emergency department complaining of head, neck, and abdominal pain after being assaulted. She denied a previous history or significant symptoms of hyperthyroidism. The physical examination was remarkable for lethargy, low-grade fever, tachycardia, facial abrasions, swelling of the anterior neck, and a tremor. A diagnosis of thyroid storm was made. An extensive work up excluded other causes of the patient's tachycardia, altered mental status, and neck swelling. A review of the clinical features and management of thyroid storm is presented. Relatively minor trauma can be a precipitating event for thyroid storm.
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Affiliation(s)
- D Yoshida
- Emergency Services, San Francisco General Hospital, University of California San Francisco, USA
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Abstract
Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.
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Affiliation(s)
- P D Pearigen
- Department of Emergency Medicine, Naval Medical Center, San Diego, California, USA
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Abstract
Despite earlier recognition and treatment of hyperthyroidism, thyroid storm remains a life-threatening, although fortunately rare, medical emergency. Prompt recognition and aggressive treatment employing a multifaceted approach are generally effective at correcting the homeostatic decompensation that is the hallmark of thyroid storm. Research is furthering understanding of the cellular actions of thyroid hormone and may lead to additional, even more effective treatment modalities in the future.
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Affiliation(s)
- S T Tietgens
- Division of Endocrinology and Metabolism, Albany Medical College, New York
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