Postpartum Thyroid Storm in Poorly Controlled Graves’ Disease: A Case Report

Peace, Jack M.; Hire, Matthew G; Peralta, F Marcela

doi:10.1213/xaa.0000000000001059

Cited by 4 publications

(10 citation statements)

References 8 publications

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“…Patients with hyperthyroidism during pregnancy with poor control could precipitate a thyroid crisis. 1 In this case, there was poor control during pregnancy where patient stopped taking the drug for a year. The patient was referred from Bangkalan Hospital, 7…”

Section: Discussionmentioning

confidence: 86%

“…Thyroid crisis is a rare complication of hyperthyroidism, with a 10 times greater risk of occurring during pregnancy 1 . The term "storm" describes the intensity of clinical manifestations and the significant increase in levels of thyroxine (T4) and triiodothyronine (T3) 2,3 .…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of hyperthyroidism during pregnancy is relatively rare and usually treated medically with the drug thioamide. One of the most dreaded symptoms of hyperthyroidism is thyroid crisis/ thyroid storm, with a mortality rate of >10% 1,2,4,5 . In the United States survey, the incidence of thyroid storm ranged from 0.57 to 0.76 cases per 100,000 per year in the normal population.…”

Section: Introductionmentioning

confidence: 99%

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Thyroid Storm in Post-Partum in Bangkalan Hospital: A Case Report

Lambu Henderika Dacosta,

Ferdy Royland. Marpaung

2021

Indian Journal of Forensic Medicine & Toxicology

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Thyroid crisis is a rare complication of hyperthyroidism, with a greater risk about 10 times during pregnancy, also clinical manifestations and significant increasing of level of thyroxine (T4) and tri-iodothyronine (T3). Thyroid crisis could cause mortality in >10%. A 58-year-old female was referred from Bangkalan Hospital, presented with palpitation, shortness of breath, diarrhea 2-3×/day, vaginal bleeding, fever for 1 day before admittance. Hyperthyroid for 3 years ago and routinely consumed thyrozol (1×2tab) in 2 years but did not take the medicine for 1 year ago. Physical examination: BP 147/100 mmHg, pulse rate 124×/minute, temperature 38.4 ºC, RR 30/minute, conjunctiva anemia, thyroid palpable, exopthalmus. ECG results: presence of sinus tachycardia, Chest X-Ray: cardiomegaly. Burch Wartofsky Score obtained a total score of 45, (temperature 38.5 C=15, diarrhea=10, tachycardia=15, CHF=5). Laboratory results: TSH <0.004 IU/ mL, FT4 5.31 ng/dl. Thyroid crisis is a rare case of hyperthyroidism, a greater risk during pregnancy which could lead to death. Many symptoms arise in hyperthyroidism which could lead to thyroid crisis. The criteria which used to assess thyroid analysis is the Burch Wartofsky Score, FT4 levels increased 5.31 ng/dl. This patient was diagnosed as thyroid storm in post-partum, based on Burch Wartofsky Score, low TSH level and an elevated FT4 level and not taking medicine for 1 year ago.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thyroid Storm in Post-Partum in Bangkalan Hospital: A Case Report

Lambu Henderika Dacosta,

Ferdy Royland. Marpaung

2021

Indian Journal of Forensic Medicine & Toxicology

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“…The diagnosis of a thyroid storm was confirmed using the BWPS from manifestations including a body temperature of 37.6 °C, agitation status, recent diarrhea, heart rate >140/min, pulmonary edema, and precipitant history. Many cases of thyroid storms during pregnancy have been reported previously ( Table 3 ) [ 1 , 5 , 6 , 7 , 8 , 9 , 10 ]. All of these cases developed a thyroid storm during the peripartum period, but none of these published case reports mentioned thyrotoxicosis-related gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Storm Superimposed on Gestational Hypertension: A Case Report and Review of Literature

Chen

Liao

et al. 2022

Medicina

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A thyroid storm is an extreme manifestation of thyrotoxicosis, and is life threatening without an early diagnosis. Pregnancy or childbirth may worsen maternal hyperthyroidism or induce the development of a thyroid storm. Gestational hypertension, a disorder defined as new-onset hypertension, develops after 20 weeks of gestation and shares symptoms with a thyroid storm. The diagnosis of a thyroid storm may be challenging in patients with gestational hypertension. To highlight the significance of early thyrotoxicosis-related gastrointestinal symptoms, we report a case of a 38-year-old woman with a twin pregnancy, who was diagnosed with gestational hypertension, and then developed a thyroid storm during the peripartum period. She complained of nausea and abdominal pain, followed by tachycardia, hypertension, and a disturbance of consciousness with desaturation. After emergency caesarean section, fever, diarrhea, and high-output heart failure, with pulmonary edema, were noted during the postoperative period in the intensive care unit. The diagnosis of a thyroid storm was confirmed using the Burch–Wartofsky point scale, which was 75 points. In this patient, the uncommon gastrointestinal symptoms, as initial manifestations of thyrotoxicosis, indicated the development of a thyroid storm. The distinguished presentation of thyrotoxicosis-induced cardiomyopathy and peripartum cardiomyopathy also helped in the differential diagnosis between a thyroid storm and gestational hypertension. Aggressive treatment for thyrotoxicosis should not be delayed because of a missed diagnosis.

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“…11 The literature related to TS was searched from 2016 to 2019, and the clinical characteristics of gastrointestinal symptoms in patients with TS were found to mainly be nausea, and the main cause of TS to be Graves' disease with unknown or poor compliance with anti-thyroid drugs (Table 3). [33][34][35][36][37][38][39][40][41][42][43][44][45][46] Considering that hiccups are not common in either DKA or TS, we speculate that the incidence of intractable hiccups is rare when DKA overlaps with TS. By carefully searching the literature, we found the following related cases.…”

Section: Case Presentationmentioning

confidence: 99%

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

Jiang

Zhong

et al. 2020

Therapeutic Advances in Endocrinology

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Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves’ disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.

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Postpartum Thyroid Storm in Poorly Controlled Graves’ Disease: A Case Report

Cited by 4 publications

References 8 publications

Thyroid Storm in Post-Partum in Bangkalan Hospital: A Case Report

Thyroid Storm in Post-Partum in Bangkalan Hospital: A Case Report

Thyroid Storm Superimposed on Gestational Hypertension: A Case Report and Review of Literature

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

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