Sudden unexpected death in the setting of undiagnosed Graves’ disease

Abstract

Graves' disease is the most common cause of hyperthyroidism and is classically characterized by the clinical triad of diffuse toxic goiter, infiltrative ophthalmopathy with exophthalmos and an infiltrative dermopathy. While the name of the Irishman Robert Graves has received the eponymous honor, the first description of the condition in the English language can be attributed to the Englishman Caleb Perry, while in continental Europe the entity in name once honored Karl von Basedow. We present the case of a previously well 43 year old woman who presented in supraventricular tachycardia and acute pulmonary edema and died despite treatment and without a diagnosis for cause of death. At autopsy the significant positive macroscopic findings were confined to the lungs (acute pulmonary edema) and thyroid (diffusely enlarged). Histology revealed features typical of Graves' disease while post mortem thyroid function tests supported a diagnosis of thyrotoxic crisis in the setting of undiagnosed Graves' disease.

Chemiluminescent immunoassay technology: what does it change in autoantibody detection?

“…This is the case, for example, with ANCA-associated small-vessel vasculitis, particularly Goodpasture syndrome with its characteristic circulating anti-glomerular basement membrane antibodies [41], and with Graves–Basedow disease, which is induced by anti-TSH receptor antibodies, in which thyroid crisis is the initial presentation [42, 43]. …”

Automation, consolidation, and integration in autoimmune diagnostics

“…This is the case, for example, for ANCA-associated small-vessel vasculitides or Goodpasture’ syndrome [ 36 ], or for patients with acute cardiovascular symptoms (thyroid storm, atrial fibrillation, supraventricular tachycardia, etc.) in undiagnosed TSH-receptor antibody-dependent Graves’ disease [ 37 , 38 ]. Another condition involves patients affected by catastrophic anti-phospholipid syndrome with concurrent thrombotic and hemorrhagic manifestations [ 39 ].…”

Sudden thyroid death. A systematic review

“…Thyroid pathology Age Gender [3] Hypothyroidism, pulmonary thromboembolism F [3] Hypothyroidism, pulmonary thromboembolism M [4] Hyperthyroidism, Graves F [5] Hyperthyroidism F [6] Black thyroid F [7] Hyperthyroidism F [8] Gossypiboma M [9] Apituitarism, 13q-syndrome M [10] Lymphocytic hypophysitis F [11] Hyperthyroidism +Type 1 DM F [11] Hyperthyroidism +Type 1 DM F [12] Lymphocytic thyroiditis M [12] Lymphocytic thyroiditis F [12] Lymphocytic thyroiditis F [12] Lymphocytic thyroiditis F [13] Hyperthyroidism F [14] Lymphocytic thyroiditis, hypothyroidism M [15] Hashimoto F [15] Hyperthyroidism M [2] Myxedema M [16] Hyperthyroidism F [17] Hyperthyroidism F [18] Subclinical thyroid pathology F [19] Hashimoto Young F [20] Hypothyroidism M [20] Hyperthyroidism M [20] Hyperthyroidism, fulminant thyroiditis M [21] After subtotal thyroidectomy for Hyperthyroidism, laryngospasm F [22] Lymphoid thyroiditis F [23] Hyperthyroidism F [23] Partial thyroidectomy after Hyperthyroidism F [24] Hyperthyroidism +hypokalemic periodic paralysis M [25] Hyperthyroidism F [26] Hyperthyroidism F [27] Hyperthyroidism F [28] Hypothyroidism F [29] Hyperthyroidism F [30] Atrophic thyroiditis, hypothyroidism, myxedema related cardiac tamponade F [31] Thyroid hormone abuse F…”

“…Hyperthyroidism was usually caused by Graves' disease or toxic multinodular goiter, but other causes were identified as well, including thyroiditis or autonomously functioning thyroid adenoma [35]. Direct cause of death was usually considered thyrotoxic crisis [4,5,25,27]. Three articles presented more particular cases of thyroid involvement in sudden death, and will be summarized below.…”

“…Pulmonary edema [4,7,20], interstitial fibrosis [5,13,61], cardiomegaly [5], lymphocytic infiltration affecting other organs [13,25] are often described in literature in association with sudden thyroid death. Another frequent occurrence is thymus lymphocytic hyperplasia, an autoimmune pathology that is known to be associated with Graves' disease [73] especially in younger patients.…”