Thyroid Storm in a Patient With COVID-19

Rao, Angela N.; Al-Ward, Ruaa; Gaba, Ruchi

doi:10.1016/j.aace.2021.06.011

Cited by 5 publications

(9 citation statements)

References 14 publications

(14 reference statements)

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“…Some specific clinical characteristics that strengthen the suspicion of a patient having a thyroid crisis are high fever, tachycardia, nausea, agitation and changes in mental status. In patients with suspected thyroid crisis, assess with the Burch-Wartosky table to calculate the clinical index score for thyroid crisis (Milani et al, 2021;Rao et al, 2021). Thyroid storm requires immediate and aggressive emergency medical attention.…”

Section: Resultsmentioning

confidence: 99%

Impending tyroid storm

Prameswari¹,

Fadli²

2022

midwifery

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Thyroid storm is an emergency and requires immediate treatment. Diagnosing thyroid storm is difficult because of its clinical symptoms that mimic infection such as tachycardia, high fever, and sometimes shortness of breath. This study employs a case study approach. The research subjects were patients with impending thyroid storm. The research location is in the Emergency Unit of Cibinong Hospital. Data analysis techniques using literature studies. In this case, a 30-year-old man at the Emergency Unit of Cibinong Hospital presented a clinical Impending Thyroid Storm with multi-organ involvement including Thyroid Heart Disease in the form of Atrial Fibrillation, gastrointestinal complaints, Hypoglycemia accompanied by Respiratory Failure. The patient has been diagnosed with Graves Disease for 5 years. Treatment for this patient includes correction of hypoglycemia, diuretics and digoxin. Propylthiouracil (PTU) and Propranolol were given when the FT4 and TSH results were out. After being treated with this therapy, clinically improved, marked by reduced tightness, fever and palpitations. On the ecg examination, atrial fibrillation was not found again. Recognizing Thyroid Storm as early as possible can prevent the severity of complications. Hypoglycemia correction is no less important. PTU therapy, Propranolol, Furosemide, Spironolactone and Digoxin are still good therapeutic modalities to be used, especially in type B hospitals.

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Section: Resultsmentioning

confidence: 99%

Impending tyroid storm

Prameswari¹,

Fadli²

2022

midwifery

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“…A TS is a rare condition that affects about 1% of pregnant women with hyperthyroidism. A TS is a severe exacerbation of thyrotoxicosis, which is an emergency disease that causes tachycardia, hyperthermia, agitation, and altered mental status[ 2 ]. It is known that TS has a variety of causes.…”

Section: Discussionmentioning

confidence: 99%

“…The thyroid function test showed a thyroid stimulating hormone (TSH) level of < 0.01 mIU/L [3 rd trimester-specific reference range (3TRR): 0.38-4.04 mIU/L[ 6 ]], free T4 level of 1.95 ng/dL (3TRR: 0.5-0.8 ng/dL[ 6 ]), and total T3 level of 183.9 ng/dL (3TRR: 123-162 ng/dL[ 6 ]), which reflect overt hyperthyroidism. According to the Burch-Wartofsky Point Scale (BWPS)[ 2 ], the score was 65, which was highly suggestive of a TS.…”

Section: Case Presentationmentioning

confidence: 99%

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Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Kim¹,

Yang²,

Park³

et al. 2023

World J Clin Cases

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BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2. CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room (ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction (PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test, serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography, and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient's condition worsened, and a cesarean section was performed under general anesthesia; a healthy boy was delivered, and 12 h after delivery, the patient's seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves' disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures. CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.

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“…Laboratory results demonstrated very low TSH levels (TSH<0.01 mIU/L) and high levels of FT4 (5.34 ng/dL) and TT3 (654 ng/dL). Thyroid ultrasound revealed heterogeneous echotexture with increased vascularity ( 158 ).…”

Section: Thyroid Dysfunction During Covid-19mentioning

confidence: 99%

COVID-19 and thyroid function: What do we know so far?

Rossetti

Cazarin²,

Hecht³

et al. 2022

Front. Endocrinol.

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Coronavirus disease 2019 (COVID-19) was characterized as a pandemic in March, 2020 by the World Health Organization. COVID-19 is a respiratory syndrome that can progress to acute respiratory distress syndrome, multiorgan dysfunction, and eventually death. Despite being considered a respiratory disease, it is known that other organs and systems can be affected in COVID-19, including the thyroid gland. Thyroid gland, as well as hypothalamus and pituitary, which regulate the functioning of most endocrine glands, express angiotensin-converting enzyme 2 (ACE2), the main protein that functions as a receptor to which SARS-CoV-2 binds to enter host cells. In addition, thyroid gland is extremely sensitive to changes in body homeostasis and metabolism. Immune system cells are targets for thyroid hormones and T3 and T4 modulate specific immune responses, including cell-mediated immunity, natural killer cell activity, the antiviral action of interferon (IFN) and proliferation of T- and B-lymphocytes. However, studies show that patients with controlled hypothyroidism and hyperthyroidism do not have a higher prevalence of COVID-19, nor do they have a worse prognosis when infected with the virus. On the other hand, retrospective observational studies, prospective studies, and case reports published in the last two years reported abnormal thyroid function related to acute SARS-CoV-2 infection or even several weeks after its resolution. Indeed, a variety of thyroid disorders have been documented in COVID-19 patients, including non-thyroidal illness syndrome (NTIS), subacute thyroiditis and thyrotoxicosis. In addition, thyroid disease has already been reported as a consequence of the administration of vaccines against SARS-CoV-2. Overall, the data revealed that abnormal thyroid function may occur during and in the convalescence post-COVID condition phase. Although the cellular and molecular mechanisms are not completely understood, the evidence suggests that the “cytokine storm” is an important mediator in this context. Thus, future studies are needed to better investigate the pathophysiology of thyroid dysfunction induced by COVID-19 at both molecular and clinical levels.

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Thyroid Storm in a Patient With COVID-19

Cited by 5 publications

References 14 publications

Impending tyroid storm

Impending tyroid storm

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

COVID-19 and thyroid function: What do we know so far?

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