Sudden thyroid death. A systematic review

Abstract

Sudden death due to thyroid disorders is a rare occurrence in forensic practice. Marked changes of thyroid plasma hormones in short periods of time are known to be life threatening, but they are usually identifiable in patients with known thyroid disorders, and therefore do not comply with the definition of sudden death. In order to properly identify published sudden thyroid death cases we performed an extensive search on Web of Science. We found 31 articles containing case presentations of possible sudden thyroid deaths, from which were identified a total number of 42 cases. There are three main thyroid pathologies associated with sudden unexpected death: hyperthyroidism (usually in the context of a Graves' disease or toxic multinodular goiter), hypothyroidism (usually associated with Hashimoto's thyroiditis), and lymphocytic thyroiditis (most likely associated with lymphocytic hypophysitis). We also present a diagnosis algorithm for detecting thyroid and related pathologies in sudden unexpected deaths.

An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis

“…Sudden death is sometimes attributable to known thyroid disorders [6]; additionally, several deaths caused by undiagnosed thyroid disease have been reported [7][8][9][10][11]. Even in individuals with known thyroid disorders, most sudden deaths are related to hyperthyroidism caused by Graves disease and toxic multinodular goiter [6]. To the best of our knowledge, death caused by hyperthyroidism based on undiagnosed chronic thyroiditis has never been reported.…”

“…Because the gross appearance is close to normal in some individuals with fatal thyroid disease [6], it is difficult to assess the contribution of thyroid disease to causing death purely on the basis of macroscopic autopsy findings. Because symptoms and clinical signs of endocrine disorders are due to an excess or decrease in bioactive hormones, evaluation of hormone profiles is necessary to establish a postmortem diagnosis of an endocrine disorder.…”