A case of thyroid storm with a markedly elevated level of circulating soluble interleukin-2 receptor complicated by multiple organ failure and disseminated intravascular coagulation syndrome

Shimoda, Yoko; Satoh, Tetsurou; Takahashi, Hiroki; Katano-Toki, Akiko; Ozawa, Atsushi; Tomaru, Takuya; Horiguchi, Norio; Kaira, Kyoichi; Nishioka, M.; Shibusawa, Nobuyuki; Hashimoto, Kazuhito; Wakino, Shu; Mori, Masatomo; Yamada, Masanobu

doi:10.1507/endocrj.ej14-0073

Cited by 8 publications

(11 citation statements)

References 18 publications

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“…Six episodes followed an operation (including curettage in two, cesarean section, hysterectomy, thyroid cancer metastasis biopsy, and thyroidectomy) [3, 8, 13, 21, 36, 38]. Iodine exposure from amiodarone was reported in two cases [16, 31] and from CT contrast medium in three cases [15, 34, 38]. There were five cases each of thyroid hormone overdose [14], dehydration [16, 18, 27, 33, 39], and hypoglycemia [22, 29, 32, 35].…”

Section: Resultsmentioning

confidence: 99%

“…Only eight cases reported Glasgow [46] or other coma scales [15, 23, 27, 31, 32, 34, 37, 38]. In these cases, Glasgow coma scale mean and median values were 7.3 and 7.5, respectively, with a range of 3 to 12.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven patients had abnormal results from either head CT or brain MRI [20, 22, 24, 26, 32, 34, 35, 37], three of whom had a preexisting structural abnormality [25, 27, 30]. Head CT was reported in 18 cases and was read as normal in 11 cases (65%).…”

Section: Resultsmentioning

confidence: 99%

“…Head CT was reported in 18 cases and was read as normal in 11 cases (65%). Brain MRI was reported in only seven cases [33, 38] and had abnormal results in five, including reversible lesion of the splenium in the corpus callosum [37], diffuse atrophy [34], chronic lacunar infarcts in bilateral pons [30], and stroke [35]. There are no reports of functional MRI or fluorodeoxyglucose positron emission tomography in TS-related coma.…”

Section: Resultsmentioning

confidence: 99%

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Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Burmeister

2019

Journal of the Endocrine Society

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Context Coma is a serious manifestation of thyroid storm (TS) about which little is known. Objective To describe the features, duration, treatment response, and prognosis of coma in the setting of TS. Design Aggregate analysis of individual English-language case reports of coma in the setting of TS from 1935 to January 2019. Setting Hospitals. Patients Sixty-five cases were identified, 29 from case reports and 36 from case series. Interventions Antithyroid drugs, corticosteroids, beta-blockers, iodine, intubation, plasmapheresis, antibiotics, thyroidectomy, radioiodine, dialysis, and l -carnitine. Main Outcome Measures Awakening and death rates overall and in relation to administered treatments, day of coma presentation, and time from coma onset; symptoms associated with coma; TS and coma scales; thyroid and cerebrospinal laboratory tests; electroencephalogram; brain imaging; and autopsy results. Results Mortality was 38% in the setting of TS-related coma, 11% during the years 1978 to 2019 compared with 70% for 1935 to 1977. Both awakening and death commonly occurred within the first 2 days of coma onset. Reduction in total and free T4 values, and possibly also total T3 value, correlated with awakening from coma. Lower death rates were associated with use of antithyroid drugs, corticosteroids, beta-blockers, and intubation. Plasmapheresis was associated with awakening in 67% of cases but not with lower death rates. Conclusions Prognosis of coma associated with TS remains poor. Current guidelines for the early use of plasmapheresis in unresolving TS are advocated and should be considered urgently at the point of confusion or delirium in an effort to abort coma.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Burmeister

2019

Journal of the Endocrine Society

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“…Though many triggers for thyroid storm including infection, surgery, and trauma can provoke DIC (disseminated intravascular coagulation), thyroid storm could directly cause it through systemic inflammatory response syndrome. The resultant DIC could worsen the thrombocytopenia caused by thyroid storm [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

Ali

Mostafa

Fernandez

et al. 2020

Case Reports in Endocrinology

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A 38-year-old gentleman presented with thyroid storm with multiorgan involvement in the form of heart failure (thyrotoxic cardiomyopathy), respiratory failure (respiratory muscle fatigue), hepatic dysfunction, fast atrial fibrillation, pulmonary embolism, and disseminated intravascular coagulation (DIC). His Graves’ disease (GD) remained undiagnosed for nearly 8 months because apart from weight loss, he has not had any other symptoms of thyrotoxicosis. The presentation of thyroid storm was atypical (apathetic thyroid storm) with features of depression and extreme lethargy without any fever, anxiety, agitation, or seizure. There were no identifiable triggers for the thyroid storm. Apart from mechanical ventilation and continuous veno-venous renal replacement therapy in the intensive care unit, he received propylthiouracil (PTU), esmolol, and corticosteroids, which were later switched to carbimazole and propranolol with steroids being tapered down. He was diagnosed with thyrotoxic myopathy which, like GD, remained undiagnosed for long (fatigability). A high index of suspicion and a multidisciplinary care are essential for good outcome in these patients.

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Thyroid Storm (Thyrotoxic Crisis)

Wartofsky

Kłubo-Gwieździńska

2019

The Thyroid and Its Diseases

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A case of thyroid storm with a markedly elevated level of circulating soluble interleukin-2 receptor complicated by multiple organ failure and disseminated intravascular coagulation syndrome

Cited by 8 publications

References 18 publications

Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

Thyroid Storm (Thyrotoxic Crisis)

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