methimazole and Multiple-Organ-Failure

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

Topics: Amiodarone; Anti-Arrhythmia Agents; Antithyroid Agents; Cardiomyopathies; Cardiopulmonary Resuscitation; Catecholamines; Defibrillators, Implantable; Echocardiography; Electrocardiography; Female; Humans; Hyperthyroidism; Hypokinesia; Methimazole; Middle Aged; Multiple Organ Failure; Perchlorates; Sodium Compounds; Thyroidectomy; Thyrotropin; Ventricular Fibrillation

A 41-year-old man with a history of hyperthyroidism had been treated with methimazole and propranolol for the past 2 months. He developed multiorgan dysfunction with acute liver failure, severe lactic acidosis, disseminated intravascular coagulation, heart failure and acute pulmonary edema with rapid deterioration of renal function. The patient had no history of alcoholism, drug abuse, blood transfusion, or exposure to hepatitis A, B, or C. Extrahepatic obstruction was ruled out with an abdominal ultrasonogram. Serologic studies and immunologic tests were negative. This case illustrates the sudden and abrupt deterioration of multiorgan dysfunction due to antithyroid drug administration and thyroid storm. The thyroid storm score of Burch and Wartofsky was 90/140. The multiorgan dysfunction was reversed by discontinuation of the methimazole and treat with hemodialysis, steroids, cholestyramine, nonselective beta-blocker, fresh frozen plasma infusion and supportive management in the intensive care unit. The patient was discharged from the hospital with normal coagulation parameters, renal and liver function tests.

Topics: Adrenergic beta-Antagonists; Adult; Anticholesteremic Agents; Antithyroid Agents; Cholestyramine Resin; Humans; Hyperthyroidism; Male; Methimazole; Multiple Organ Failure; Propranolol; Renal Dialysis; Steroids; Thyroid Crisis

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

A 54-years-old patient coming from Guinea, who presented fever, diarrhoea, consciousness disorders and severe haemolytic anaemia, was admitted to resuscitation unit in France. Despite many explorations carried out (evaluation of traumatic causes, infection, neoplasia, vascular, toxic causes, vitamin deficiency), it was not possible to explain neurological symptomatology. Besides, haemolytic anaemia was due to the ingestion of metamizole in a context of glucose-6-phosphate dehydrogenase deficit. This drug's marketing has been suspended in France since 2006. Despite appropriate treatment, after seven days of hospitalization, the patient died of multi-organ failure and hemophagocytic syndrome. This clinical case illustrates the difficulties encountered to set a diagnosis and manage patients coming from overseas. Uncommon aetiologies for French healthcare professionals should be evoked in the absence of comprehensive clinical information.

Topics: Anemia, Hemolytic; Antithyroid Agents; Diagnosis, Differential; Diarrhea; Fatal Outcome; Glucosephosphate Dehydrogenase Deficiency; Guinea; Headache; Humans; Lymphohistiocytosis, Hemophagocytic; Malaria, Falciparum; Male; Methemoglobinemia; Methimazole; Middle Aged; Multiple Organ Failure; Paris; Psychomotor Agitation; Seizures; Vomiting