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      Surgical Management of an Atypical Presentation of a Thyroid Storm

      case-report

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          Abstract

          Introduction:

          Thyroid storm is a rare complication of Graves' disease that can carry a poor prognosis. In order to prevent major complications, thyroid storm must be quickly identified in patients and treatment must be promptly implemented. Medical treatment is usually initiated with antithyroid medications, such as propylthiouracil (PTU), methimazole, and beta-blockers. However, some patients may experience adverse reactions to these medications and alternate treatment options must be explored.

          Case Presentation:

          We report a case of a 30-year-old female initiated on PTU after diagnosis with Graves' disease that later presented an acute thyroid storm.

          Discussion:

          Therapy was changed to methimazole, yet the patient subsequently developed angioedema and dyspnea. Medical management was discontinued and emergent thyroidectomy was performed without complication.

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          Most cited references18

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          Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

          Rebecca Bahn Chair, Henry Burch, David Cooper … (2011)
          Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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            Life-threatening thyrotoxicosis. Thyroid storm.

            Henry Burch, Leonard Wartofsky (1993)
            Although important strides in recognition and therapy have significantly reduced the mortality in this disorder from the nearly 100% fatality rate noted by Lahey, survival is by no means guaranteed. More recent series have yielded fatality rates between 20% and 50%. Although some authors have attributed this improvement, in part, to a relaxation of the diagnostic criteria for thyroid storm, it more likely represents improvements in early recognition and the beneficial effects of the serial addition of antithyroid, corticosteroid, and antiadrenergic therapies to the treatment of this disorder. Thyroid storm is a dreaded, fortunately rare complication of a very common disorder. Most cases of thyroid storm occur following a precipitating event or intercurrent illness. Effective management is predicated on a prompt recognition of impending thyroid storm which is, in turn, dependent on a thorough knowledge of both the typical and atypical presentations of this disorder. An unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.
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              Thyroid emergencies.

              Nicholas Sarlis, Loukas Gourgiotis (2003)
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Endocrinol Metab
                Journal ID (iso-abbrev): Int J Endocrinol Metab
                Journal ID (doi): 10.5812/ijem
                Journal ID (publisher-id): Kowsar
                Title: International Journal of Endocrinology and Metabolism
                Publisher: Kowsar
                ISSN (Print): 1726-913X
                ISSN (Electronic): 1726-9148
                Publication date (Electronic): 01 April 2014
                Publication date Collection: April 2014
                Volume: 12
                Issue: 2
                Electronic Location Identifier: e13539
                Affiliations
                [1 ]Tufts University School of Medicine, Boston, USA
                [2 ]Department of Otolaryngology-HNS, Tufts Medical Center, Boston, USA
                [3 ]Department of Endocrinology and Diabetes, Tufts Medical Center, Boston, USA
                Author notes
                [* ]Corresponding author: Richard O. Wein, Otolaryngology Department, Tufts Medical Center, Boston, USA. Tel: +61-76368711, Fax:+ 61-7636-1479, E-mail: rwein@ 123456tuftsmedicalcenter.org
                Article
                DOI: 10.5812/ijem.13539
                PMC ID: 3997950
                PubMed ID: 24782903
                SO-VID: 940bf0e6-b413-474f-9e58-b17ff3912fcc
                Copyright © Copyright © 2014, Research Institute For Endocrine Sciences and Iran Endocrine Society; Published by Kowsar Corp.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 July 2013
                Date revision received : 15 December 2013
                Date accepted : 25 December 2013
                Categories
                Subject: Case Report

                Keywords: thyroid crisis,thyroidectomy,graves' disease,antithyroid agents
                Data availability:
                Keywords: thyroid crisis, thyroidectomy, graves' disease, antithyroid agents

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