A Patient with Thyroid Storm Presenting with Apathetic Thyrotoxicosis and Features of Meningoencephalitis

Yang, Samantha Peiling; Wu, Pang Hung; Tey, Beng Hea; Tan, Chee Kiat

doi:10.1089/thy.2010.0383

Cited by 8 publications

(11 citation statements)

References 28 publications

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“…More than one event precipitating the TS-related coma was identified in 21 cases [3, 8, 14–16, 21–24, 33, 35, 36, 38]. No precipitating event could be identified in eight cases [10, 11, 30, 40, 42, 43, 45], and 10 cases had no information on the TS-precipitating event. In some cases, it was not possible to separate precipitating events from consequences of the TS, such as seizure or stroke [15, 20, 24, 26, 35].…”

Section: Resultsmentioning

confidence: 99%

“…Positive Babinski sign was reported in five cases [20, 25, 30, 40, 42] and clonus in two [40, 42]. Seizure and stroke presented together in two patients [24], including one pediatric patient [35].…”

Section: Resultsmentioning

confidence: 99%

“…EEG was performed in 11 cases [11, 15, 20, 37], seven of which reported diffuse slowing [19, 30, 33, 38, 39, 42, 45]. LP was performed in 15 cases [11, 15, 19, 20, 22, 29, 30, 37, 38, 40, 42, 43, 45]. Low cerebrospinal fluid glucose level was reported in two cases (as 18 and 27 mg/dL) [22, 45].…”

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%

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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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“…Greater age, increased corrected calcium level, decreased TSH level, increased FT4, decreased FT3/FT4 ratio, increased bone-specific alkaline phosphatase, and increased ALT (alanine aminotransferase) may be significant in differentiating apathetic thyrotoxicosis from typical hyperthyroidism, which may aid in accurate diagnosis and treatment (7). Early detection and treatment can help in reducing morbidity and mortality (8). …”

Section: Discussionmentioning

confidence: 99%

Apathetic thyrotoxicosis presenting with diabetes mellitus

Poudel¹,

Belbase²,

Belbase³

et al. 2014

Journal of Community Hospital Internal Medicine Perspectives

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Apathetic form of thyrotoxicosis occurs in the elderly who can present with features of hyperglycemia, hypothyroidism, depression, or an internal malignancy. A clinical suspicion and timely diagnosis of hyperthyroidism is needed to define the correct etiology of existing problems, and to prevent grave complications. We discuss an 84-year-old woman who presented with fatigue and uncontrolled diabetes due to apathetic thyrotoxicosis.

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“…Previously reported series and cases are summarized in Table 2. [6][7][8][9][10][11][12][13][14][15][16] The exact pathogenic mechanism behind development of apathetic thyrotoxicosis is unclear. One theory suggests that the amount of catecholamines in the brain is 4 This case demonstrates a potential link between the untreated hyperthyroid state and the progression to the apathetic state.…”

Section: Discussionmentioning

confidence: 99%