methimazole and Heart-Arrest

Topics: Abortion, Therapeutic; Adult; Antithyroid Agents; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Hyperemesis Gravidarum; Hyperthyroidism; Methimazole; Pregnancy; Pregnancy Complications; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine; Ventricular Fibrillation

Thyroid storm is a rare, life-threatening condition which arises in patients with thyrotoxicosis, with an annual incidence of 2 patients per 1,000,000 and a mortality rate of 11%.. We present the case of a 46-year-old-female with a medical history of controlled mild intermittent asthma, who presented with a severe asthma exacerbation, that triggered thyroid storm after exposure to polyurethane fumes.. This patient represents, to the best of our knowledge, the first patient in whom the stress related to a severe asthma attack triggered the development of thyroid storm. She also is the first patient with no indication of cardiac dysfunction who developed fatal cardiac arrest after initiation of b-blockade for treatment of thyroid storm.

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Dyspnea; Fatal Outcome; Female; Heart Arrest; Humans; Inhalation Exposure; Methimazole; Middle Aged; Multiple Organ Failure; Polyurethanes; Potassium Iodide; Propranolol; Resuscitation; Thyroid Crisis

Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with β-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.

Topics: Adrenergic beta-Antagonists; Adult; Antithyroid Agents; Asphyxia; Directive Counseling; Female; Heart Arrest; Humans; Mental Disorders; Methimazole; Neck Injuries; Suicide, Attempted; Thyroid Crisis; Treatment Outcome