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

Abstract

Thyroid storm is the life-threatening end-organ manifestation of severe thyrotoxicosis. If left untreated, thyroid storm may cause acute heart failure, multiorgan dysfunction, and death. A high degree of suspicion is necessary to make the diagnosis and start antithyroid medications to decrease mortality. Thyroid storm is generally seen in patients with Graves' disease but should also be suspected in patients with fever, tachycardia, altered mental status, and risk factors including local trauma to the neck, such as strangulation. Based on our review, we report the first case of thyroid storm after strangulation as the presentation of previously undiagnosed Graves' disease.

Strangulation-Induced Thyrotoxicosis in a Patient with Undiagnosed Underlying Graves’ Disease

“…yroid storm is rare, but is most commonly seen in patients with underlying Graves' disease [1]. Mechanical trauma precipitating thyrotoxicosis and thyroid storm has been described by numerous reports, but only two previous cases of strangulation-induced thyrotoxicosis have been published as per our literature review, one similar to our case with underlying Graves' disease [7] and one without [8]. In the patient described above, Graves' disease likely predisposed to thyrotoxicosis which was precipitated by blunt force trauma to the neck.…”

“…In the patient described above, Graves' disease likely predisposed to thyrotoxicosis which was precipitated by blunt force trauma to the neck. e proposed pathophysiology states that mechanical stimulation of the thyroid gland causes excess release of preformed thyroid hormone in combination with increased catecholamine response as the result of the assault and psychologic stress that follows [7]. In fact, it is possible that psychological stress alone without the mechanical trauma could precipitate thyrotoxicosis in a patient with underlying Graves' disease.…”

Refractory Thyrotoxicosis in Oropharyngeal Squamous Cell Carcinoma Invading the Thyroid Gland

“…Furthermore, the lack of pus in the thyroid isthmus at the time of tracheostomy and lack of bacterial growth on multiple blood cultures, including one that was performed before the start of antibiotic therapy, also decreased the likelihood of acute suppurative thyroiditis. Hyperthyroidism from surgical manipulation or direct trauma to the thyroid gland during tracheostomy could also be possible (18), but unlikely as the patient displayed signs of hyperthyroidism prior to tracheostomy, and there was minimal manipulation of the gland intraoperatively.…”

Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature

“…11 The literature related to TS was searched from 2016 to 2019, and the clinical characteristics of gastrointestinal symptoms in patients with TS were found to mainly be nausea, and the main cause of TS to be Graves’ disease with unknown or poor compliance with anti-thyroid drugs (Table 3). 33-46…”

“…11 The literature related to TS was searched from 2016 to 2019, and the clinical characteristics of gastrointestinal symptoms in patients with TS were found to mainly be nausea, and the main cause of TS to be Graves' disease with unknown or poor compliance with anti-thyroid drugs (Table 3). [33][34][35][36][37][38][39][40][41][42][43][44][45][46] Considering that hiccups are not common in either DKA or TS, we speculate that the incidence of intractable hiccups is rare when DKA overlaps with TS. By carefully searching the literature, we found the following related cases.…”