Thyroid Storm Presenting as Acute Liver Failure in a Patient with Graves’ Disease

Hayat, Muhammad Hashim; Moazzam, Zorays; Ziogas, Ioannis A.; Yousaf, Amman; Hayat, Maham

doi:10.7759/cureus.10333

Cited by 8 publications

(9 citation statements)

References 12 publications

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“…13 While acute liver failure in thyroid storm is associated with increased FT3 due to mitochondrial apoptosis in hepatocytes, the pathologic mechanism for thyrotoxicosis is secondary ischemic hepatitis due to peripheral vasodilation and excessive thyroid hormone release due to acute heart failure. 14,15 In this patient, diarrhea and jaundice were manifestations of a thyroid crisis.…”

Section: Discussionmentioning

confidence: 75%

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

Hamzah

Aman

Iskandar

2022

JAFES

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Thyroid crisis is an emergency due to impaired thyroid function caused by various conditions, particularly infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that result in the dysfunction of various vital organs. We report a case of a 31-year-old Indonesian female with a 2-year history of hyperthyroidism with elevated thyroid-stimulating hormone (TSH) receptor antibodies. (TRAb) who developed thyroid crisis possibly in association with SARS-CoV-2 pneumonia, sepsis, and disseminated intravascular coagulation (DIC). Prior to admission, she was treated for her hyperthyroidism with propylthiouracil and had been in stable remission for a year. She was admitted to the Emergency Room with complaints of watery stools, icteric sclerae, jaundice, coughing, and shortness of breath. The physical examination showed a World Health Organization (WHO) performance score of 4, delirium, blood pressure within normal limits, tachycardia, tachypnea, axillary temperature of 36.7°C, icteric sclerae, jaundice, and exophthalmos. There was a 3 cm palpable nodule on the right side of the neck. Auscultation of the lungs revealed bilateral pulmonary rales. Abdominal examination noted a palpable liver and enlarged spleen. Laboratory tests showed thrombocytopenia, electrolyte imbalance, hypoalbuminemia and elevated transaminases. The thyroid function tests showed a suppressed TSH level with an elevated free thyroxine (FT4) level. The SARS-CoV-2 polymerase chain reaction (PCR) swab test was positive. Initial patient management was with supportive therapy that included favipiravir and anti-hyperthyroidism medication; however, despite these interventions, her condition continued to deteriorate and she died after a few hours. This case demonstrates no difference in therapy between patients with thyroid crises and COVID-19 or other infections. Proper and timely treatment is important for reducing mortality rates.

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Section: Discussionmentioning

confidence: 75%

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

Hamzah

Aman

Iskandar

2022

JAFES

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“…Moreover, severe LD is a rare but potentially lethal complication of GD, and its treatment is clinically important. Only a few cases of GD with severe LD have been reported to date ( 6 , 7 ), and there is no clear guidance or expert consensus regarding the management of this clinical condition.…”

Section: Introductionmentioning

confidence: 99%

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Rao

Wang²,

Ren³

et al. 2022

Front. Endocrinol.

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ObjectiveTreatment decision-making in Graves’ disease (GD) with severe liver dysfunction (LD) is a clinical challenge. This research was carried out to evaluate the effect of radioiodine (131I) with or without an artificial liver support system (ALSS) in GD patients with severe LD.MethodsIn total, 45 patients diagnosed with GD and severe LD were enrolled and allocated to two groups: patients treated with 131I alone (n=30) (Group A)and patients by a combination of 131I and ALSS (n=15)(Group B). Liver function, thyroid hormone concentrations, therapeutic efficacy, and the cost of treatment were compared between the two groups.ResultsThyroid hormone concentrations were lower 2 weeks after 131I treatment, but no deterioration in liver function was identified. There was no statistically significant difference in the treatment efficacy between the two groups. The hospital stay, total cost, and daily cost were lower in patients treated with 131I alone than in those treated with 131I and an ALSS (p<0.05).ConclusionThe key point of treating GD patients with severe LD is to control the GD.131I is recommended as an effective and safe and should be applied as soon as possible once the diagnosis is clarified; however, when used in combination with an ALSS, there was no substantial improvement in therapeutic efficacy.

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“…[ 4 ] In addition, TS manifests with multiorgan dysfunction including thermoregulatory, cardiovascular and central nervous systems. [ 5 6 ] The presence of both these predicaments is rare, and middle-aged females are the most commonly affected group. Poor adherence to treatment and or under-treatment of any one disorder is the most commonly cited reason in the literature and is also supported by the fact that almost all patients have elevated HbA1c (10.5% in our patient) and low to undetected TSH (<0.004 mIU/l in our patient).…”

Section: Discussionmentioning

confidence: 99%

Diabetic Ketoacidosis and Thyroid Storm Presentation of Two Jeopardies Concurrently in a Young Female

Qureshi

Bhatia

Shabeen

et al. 2022

Indian Journal of Endocrinology and Metabolism

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Thyroid Storm Presenting as Acute Liver Failure in a Patient with Graves’ Disease

Cited by 8 publications

References 12 publications

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

Fatal Case of Possible Thyroid Crisis Induced by SARS-CoV-2 Infection: A Case Report

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Diabetic Ketoacidosis and Thyroid Storm Presentation of Two Jeopardies Concurrently in a Young Female

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