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


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          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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          Most cited references8

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          Life-threatening thyrotoxicosis. Thyroid storm.

          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.

            This review presents current knowledge about the thyroid emergencies known as myxedema coma and thyrotoxic storm. Understanding the pathogenesis of these conditions, appropriate recognition of the clinical signs and symptoms, and their prompt and accurate diagnosis and treatment are crucial in optimizing survival. Copyright © 2012 Elsevier Inc. All rights reserved.
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              Thyroid storm with multiorgan failure.

              Thyroid storm is a rare and potentially fatal condition. Various unusual presentations in patients with thyroid storm have been described but multiorgan dysfunction is uncommonly seen. We describe a 35-year-old patient with a history of Graves' disease who was diagnosed with thyroid storm at 2 weeks postpartum. This was complicated by acute liver failure, acute kidney injury, severe lactic acidosis, disseminated intravascular coagulation, and heart failure with acute pulmonary edema. The multiorgan dysfunction was reversed by prompt institution of antithyroid drugs and supportive management in the intensive care unit. Thyroid storm is a medical emergency. One of the challenges lies in recognizing its varied presentations. Early diagnosis and appropriate treatment is important to prevent the catastrophic outcomes associated with this condition.

                Author and article information

                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                31 March 2017
                : 2017
                : 16-0115
                [1 ]Department of Internal Medicine , Division of Endocrinology and Metabolism
                [2 ]Division of Nephrology , Kosin University College of Medicine, BusanRepublic of Korea
                Author notes
                Correspondence should be addressed to S K Kwon; Email: mir316@ 123456naver.com
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                : 20 January 2017
                : 8 February 2017
                Novel Treatment


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