Thyroid storm following suicide attempt by hanging

Abstract

Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with β-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.

Review article: Non‐fatal strangulation: Hidden injuries, hidden risks

“…Damaged to thyroid tissue has resulted in thyroid storm after hanging and strangulation with a ligature in case reports …”

“…40,71 Thyroid storm Damaged to thyroid tissue has resulted in thyroid storm after hanging and strangulation with a ligature in case reports. 23,72 Delayed anoxic encephalopathy Delayed anoxic encephalopathy has been described as brain damage that has presented days to weeks later. 10 Blindness, choreoathetosis, dystonia, pseudobulbar paralysis have occurred in people who initially appeared normal.…”

Transient Hyperthyroidism Induced by Thyroid Ultrasound

“…Hyperthyroidism has been reported following blunt trauma, strangulation, hanging, aspiration of thyroid cysts, hemorrhage into thyroid nodules, and even palpation. [4][5][6][7][8][9][14][15][16][17] Several other facts support the concept that direct thyroid injury is the etiology of postoperative or traumatic hyperthyroidism. Iodine uptake by the thyroid gland is markedly reduced, and in almost every case, there is no evidence of abnormal anti-thyroid or TSH receptor antibodies to suggest underlying autoimmune thyroid disease.…”

“…[1][2][3] Additionally, transient hyperthyroidism has been reported following blunt trauma to the anterior cervical region, strangulation, and vigorous palpation of the thyroid gland. [4][5][6][7][8][9] In almost all reported cases, hyperthyroidism was noted within several days of the inciting event and spontaneously resolved after 2 to 4 weeks.…”

Thyroid Storm Triggered by Strangulation in a Patient with Undiagnosed Graves’ Disease

“…Hypotheses for thyroid storm due to trauma include a release of preformed thyroid hormone due to ruptured acini, increased responsiveness to catecholamines, and enhanced cellular responses to thyroid hormone [1–4, 6, 8]. …”