Thyroid Storm with Multiorgan Failure

Hui Wen Chong; Kay Choong See; Jason Phua

doi:10.1089/thy.2009.0181

Challenging Thyroid Storm in Pregnancy, Case Report

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1887 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A923-A924

Author(s):

Zaina Abdelhalim Alamer ◽

Mohammed Alkhatib ◽

Emad Naem ◽

Noor Nabeel M Suleiman ◽

Marwa Gomaa Mokhtar ◽

...

Keyword(s):

Case Report ◽

Liver Function ◽

Calcium Supplementation ◽

Rare Complication ◽

Multiorgan Failure ◽

Medical Emergency ◽

Thyroid Storm ◽

Dilation And Curettage ◽

Definitive Therapy ◽

In Pregnancy

Abstract Background: Thyroid storm is a rare complication of hyperthyroidism. It can lead to life-threatening complications such as Arrhythmias, multiorgan failure and disseminated intravascular coagulation (DIC) (1). In pregnant patients can cause spontaneous abortions, fetal demise (2). Aggressive treatment under critical care settings is needed. Clinical Case: We report a case of 24-year-old Indian female twelve weeks pregnant; background of Graves’ disease for five years, was on carbimazole but she discontinued since she became pregnant. Presented to Hamad general hospital with nausea, vomiting and altered mental status for one day. She was afebrile, normotensive, tachypneic, tachycardiac with heart rate of 150bpm, and confused. Investigations showed supraventricular tachycardia aborted by adenosine and amiodarone, TSH was < 0.01mIU/l(0.3-4.2) and FT4> 100 pmol/L(11.6-21.9),normal baseline liver function and complete blood counts. In the emergency department, she was managed for thyroid storm with hydrocortisone, propranolol, propylthiouracil (PTU), iodine solution and cholestyramine. Then suddenly she deteriorated requiring intubation and vasopressor support under care of Medical Intensive Care Unit (MICU) progressed to multiorgan failure; acute liver injury, acute kidney injury and DIC. So, PTU was stopped and started on plasma exchange followed by total thyroidectomy and tracheostomy. US pelvis showed nonviable fetus, so dilation and curettage were done by obstetric team. Afterwards, she markedly improved except her conscious level and kidney function which required Hemodialysis. MRI brain showed small subdural hematoma treated conservatively and Wernicke encephalopathy treated with thiamine with substantial response and spontaneously breathing. Post thyroidectomy she required calcium supplementation and levothyroxine, liver function and coagulation parameters back to baseline. Conclusion: Thyroid storm in pregnancy is a medical emergency with high mortality rate, it needs high index of suspicion and early aggressive management by a multidisciplinary team. Plasmapheresis may be considered for challenging cases as a bridge for definitive therapy. Thyroidectomy may be the only option in selected cases like our case. References: 1. Karger S, Führer D. Thyreotoxische Krise--ein Update [Thyroid storm--thyrotoxic crisis: an update]. Dtsch Med Wochenschr. 2008 Mar;133(10):479-84. German. doi: 10.1055/s-2008-1046737. PMID: 18302101. 2. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9606. doi:10.1097/MD.0000000000009606

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Thyroid Storm Presenting with Multiorgan Failure and Severe Lactic Acidosis

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a1712 ◽

2019 ◽

Author(s):

J.D. Price ◽

K. El-Kersh

Keyword(s):

Lactic Acidosis ◽

Multiorgan Failure ◽

Thyroid Storm ◽

Severe Lactic Acidosis

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A Rare Case of Fatal Thyroid Storm (TS) Resulting in DIC and Multiorgan Failure

CHEST Journal ◽

10.1378/chest.1992592 ◽

2014 ◽

Vol 146 (4) ◽

pp. 302A

Author(s):

Amareshwar Podugu ◽

Khulood Rizvi ◽

Chandra Dasari ◽

Asha Chakka ◽

Nihad Boutros

Keyword(s):

Rare Case ◽

Multiorgan Failure ◽

Thyroid Storm

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Thyroid Storm with Multiorgan Failure Treated with Plasmapheresis

Case Reports in Endocrinology ◽

10.1155/2019/2475843 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ann Miller ◽

Kristi D. Silver

Keyword(s):

Heart Failure ◽

Medical Therapy ◽

Multiorgan Failure ◽

Ventricular Rate ◽

Thyroid Storm ◽

Free T4 ◽

Hormone Production ◽

Alternative Treatment Option ◽

Severe Manifestation ◽

Maximal Medical Therapy

Background. Thyroid storm is a severe manifestation of thyrotoxicosis and can present with multiorgan failure. First line treatment of thyroid storm is directed towards decreasing thyroid hormone production and peripheral conversion of T4 to T3, and treating adrenergic symptoms. When medical therapy fails, plasmapheresis is an alternative treatment option. Here we present a patient with thyroid storm and multiorgan failure who was treated with plasmapheresis. Case. A 50-year-old male with a history of hyperthyroidism, hypertension, and congestive heart failure presented to another hospital with fever and altered mentation. He was found to have pneumonia on imaging and was started on antibiotics. He developed shock complicated by atrial fibrillation with rapid ventricular rate which was treated with amiodarone. He was transferred to our hospital for further management. On arrival, TSH was <0.01 mIU/L, free T4 was >7 ng/dL and total T3 was 358 ng/dL. The endocrinology team determined he was in thyroid storm. His medical treatment of thyroid storm was aggressively titrated to maximal therapy. His hospital course was complicated by transaminitis, respiratory failure requiring intubation, shock requiring vasopressor support, kidney failure requiring continuous renal replacement therapy, and heart failure. Despite maximal anti-thyroid therapy, he had not improved clinically and T4 and T3 remained markedly elevated. A 4-day course of plasmapheresis was initiated resulting in marked lowering of T4 and T3 and clinical stability. Conclusion. While current guidelines for plasmapheresis for thyroid storm recommend individualized decision making, no further clarification is provided on who would be a good candidate for the procedure. We present a patient with thyroid storm and multiorgan failure who was treated with plasmapheresis after failing maximal medical therapy. Given the significant improvement seen with plasmapheresis, endocrinologists should consider this mode of treatment earlier in the course of thyroid storm when patients are not improving with medical therapy alone.

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Nondiabetic Endocrine Emergencies 2: Hypoparathyroidism, Hyperparathyroidism, Myxedema Coma, And Thyroid Storm

10.2310/em.4700 ◽

2018 ◽

Author(s):

Jason J Lewis ◽

Richard E Wolfe

Keyword(s):

Multiorgan Failure ◽

Signs And Symptoms ◽

Metabolic Effects ◽

Thyroid Storm ◽

Emergency Setting ◽

Course Of Illness ◽

Myxedema Coma ◽

Adrenergic Activity ◽

Parathyroid Disease ◽

History Of

Acute emergent presentations of the thyroid and parathyroids are rarer occurrences in the emergency department but essential to diagnose and treat early in the course of illness. Disorders of the parathyroids are typically related to circulating calcium levels and the metabolic effects thereof, whereas thyroid deficiency or excess can lead to profound shock, coma, hypothermia, hyperthermia, and death. The diagnosis of parathyroid disease should be considered in patients presenting with signs and symptoms consistent with hyper- or hypocalcemia. Myxedema coma should be considered in any patient presenting with evidence of severe sepsis or shock, particularly when there is a history of hypothyroidism. Thyroid storm should be suspected in any patient with unexplained increased adrenergic activity, hyperpyrexia, or multiorgan failure. Empirical treatment must begin prior to definitive diagnosis in all cases. This review demonstrates how to recognize and manage acute presentations of hypo- and hyperparathyroidism, myxedema coma, and thyroid storm in the emergency setting. Patients with nondiabetic endocrine emergencies may present in extremis, and immediate stabilization, typically without confirmatory testing, is necessary. Early intervention is key in treating such presentations. This review contains 3 figures, 8 tables and 28 references Key words: disorders of the parathyroids, hyperparathyroidism, hypoparathyroidism, hypothyroidism, myxedema coma, thyroid storm, thyrotoxicosis

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Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-16-0115 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 2

Author(s):

Han Soo Park ◽

Su Kyoung Kwon ◽

Ye Na Kim

Keyword(s):

Cardiac Arrest ◽

Renal Replacement Therapy ◽

Body Temperature ◽

Medical Treatment ◽

Replacement Therapy ◽

Multiorgan Failure ◽

Antithyroid Drug ◽

Thyroid Storm ◽

List Type ◽

Conventional Medical Treatment

Summary Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED). She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT) with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment. Learning points: The presenting manifestations of thyroid storm vary and can include cardiac arrest with multiorgan failure in rare cases. In some patients with thyroid storm, especially those with severe complications, conventional medical treatment may be ineffective or inappropriate. During thyroid storm, the initiation of CRRT can immediately lower body temperature and subsequently stabilize vital signs. Early initiation of CRRT can be life-saving in patients with thyroid storm complicated by MOF, even when used in combination with suboptimal medical treatment.

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