Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review

Abstract

Thyroid storm is a potentially fatal manifestation of thyrotoxicosis. Cardiopulmonary failure is the most common cause of death in thyroid storm. Clinicians should keep in mind that thyroid storm complicated with cardiopulmonary failure can be the first presentation of thyrotoxicosis. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance in the management of thyrotoxicosis. A high index of suspicion and the ability of early recognition of impending thyroid storm depends on a thorough knowledge of both the typical and atypical clinical features of this illness. Herein, we report a case of thyroid storm presenting as cardiopulmonary failure in a 51-year-old woman with undiagnosed Grave’s disease. Additionally, we review the pathophysiology of cardiopulmonary failure associated with thyrotoxicosis and various treatment modalities for thyroid storm.

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

“…Inspiratory muscle fatigue and failure causing respiratory acidosis, necessitating mechanical ventilation, is not uncommon with thyroid storm, as thyrotoxicosis is known to decrease the muscle mass by 20% and muscle strength by 40% [ 19 ]. Various mechanisms for acute respiratory failure include pulmonary oedema [ 19 ], pulmonary embolism [ 20 ], thyrotoxic myopathy, thyrotoxic periodic paralysis, rhabdomyolysis, polymyositis, or coexisting myasthenia gravis [ 21 ].…”

Normothermic Thyroid Storm with Circulatory Collapse: An Unusual Presentation

“…It decreases peripheral conversion of T4 to T3 but helpful in associated adrenal insufficiency and control of vasomotor symptoms. [12] Thionamides, which include propylthiouracil and methimazole, are used. These block synthesis of thyroid hormones.…”

Thyroid Storm: Clinical Manifestation, Pathophysiology, and Treatment

“…Overall mortality rate has been reported to be 10-20% [4,[10][11][12]. Multiple system dysfunction is the commonest cause of death, followed by heart failure [13], respiratory failure [13], and sepsis [3,14].…”