methimazole and Disseminated-Intravascular-Coagulation

A 62-year-old woman with a history of partially treated Graves disease and hypertension presented with approximately 3 weeks of worsening fatigue, lower extremity myalgias, and shortness of breath. Her medical history included a thyroid radiofrequency ablation several years earlier. Following the ablation, she was found to have some residual thyroid activity, negating the need for therapy. She was lost to follow-up after months of normal thyroid-stimulating hormone values. On this presentation, the patient was noted to be in atrial fibrillation with a rapid ventricular rate, and although she presented alert and oriented initially, she developed progressive inattentiveness and confusion while in the ED. The patient was transferred to the medical ICU for further management of her rapid heart rate and progressive delirium.

Topics: Anti-Arrhythmia Agents; Anti-Inflammatory Agents; Anticoagulants; Antithyroid Agents; Atrial Fibrillation; Delirium; Disseminated Intravascular Coagulation; Dyspnea; Fatal Outcome; Fatigue; Female; Femoral Artery; Graves Disease; Heparin; Humans; Hydrocortisone; Ischemia; Lower Extremity; Methimazole; Middle Aged; Myalgia; Pneumoperitoneum; Popliteal Artery; Potassium Iodide; Propranolol; Radiofrequency Ablation; Thrombosis; Thyroid Crisis; Tibial Arteries; Venous Thrombosis

Male, 23.. Thyroid storm.. Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight loss.. -.. Endocrinology and Metabolic.. Unusual clinical course.. The clinical presentation of thyroid storm includes fever, tachycardia, hypertension, and neurological abnormalities. It is a serious condition with a high mortality rate. Furthermore, some other complications affect the clinical course of thyroid storm. Although it is reported that prognosis is poor when thyroid storm is complicated by disseminated intravascular coagulation syndrome (DIC) and leukopenia, reports of such cases are rare.. A 23-year-old man presented with delirium, high pyrexia, diarrhea, and weight loss of 18 kg over 2 months. According to the criteria of Burch and Wartofsky, he was diagnosed with thyroid storm on the basis of his symptom-complex and laboratory data that confirmed the presence of hyperthyroidism. Investigations also found leukopenia, thrombocytopenia, and disseminated intravascular coagulation, all of which are very rare complications of thyroid storm. We successfully treated him with combined therapy including anti-thyroid medication, despite leukopenia.. Early diagnosis and treatment are essential in ensuring a good outcome for patients with this rare combination of medical problems.

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Humans; Iodates; Leukocyte Count; Leukopenia; Male; Methimazole; Potassium Compounds; Propranolol; Thyroid Crisis; Young Adult

Thyroid storm is a rare disorder with a sudden onset, rapid progression and high mortality. We experienced a case of thyroid storm which had a devastating course, including multiple organ failure (MOF), severe hypoglycemia, disseminated intravascular coagulation (DIC), and stroke. It was difficult to make a diagnosis of thyroid storm in the present patient, because she did not have a history of thyroid disease and her serum FT3 level was normal. Clinicians should be aware that thyroid storm can occur even when there is an almost normal level of thyroid hormones, and that intensive anticoagulation is required for patients with atrial fibrillation to prevent stroke after thyroid storm.

Topics: Anti-Inflammatory Agents; Anticoagulants; Antithyroid Agents; Brain Edema; Decompression, Surgical; Disseminated Intravascular Coagulation; Female; Gabexate; Humans; Hydrocortisone; Methimazole; Middle Aged; Multiple Organ Failure; Stroke; Thyroid Crisis; Treatment Outcome; Triiodothyronine; Warfarin