Idiopathic thyroid storm mimicking SIRS in a patient with hypothyroidism- a diagnostic dilemma. Issue 6 (2nd November 2018)

• Record Type: Journal Article
• Authors: Shah, Syed Raza; Millan, Terance; Alamzaib, Sardar Muhammad; Luu, Sue-Wei
• Is Part Of: Journal of community hospital internal medicine perspectives. Volume 8:Issue 6(2018)
• Page Start: 368
• Page End: 369
• Publication Date: 2018-11-02
• Subjects: Thyroid storm -- TSH -- free t4 -- diagnostic dilemma -- hypothyroidism; Internal medicine -- Periodicals; Hospitals -- Periodicals; Hospitals, Community; Internal Medicine; Hospitals; Internal medicine; Periodicals; Periodicals; 610
• DOI: 10.1080/20009666.2018.1547090
• Languages: English
• ISSNs: 2000-9666

Abstract

ABSTRACT: Thyroid storm, defined as an endocrine emergency in 1926, remains a challenge for physicians in the 21 st century. The mortality rate of untreated thyroid storm is very high. Hence, if a thyroid storm is suspected, treatment should not be delayed. This disease can be fatal! We present the case of a 86-year-old female presenting with altered mental status. All the tests came out negative except for elevated free t4 (ft4) with a very low TSH level (ft4-7.87, TSH< 0.005). Patient was diagnosed with thyroid storm in the setting of subclinical hypothyroidism and improved significantly with treatment. Furthermore, it is essential to confirm the TSH level in a patient with subclinical hypothyroidism. By carefully finding the extent of the disease, one can easily distinguish between hypo-or hyper- thyroid disease. The clinical features of thyroid storm may be related to other co-morbidities which makes diagnosis a clinical challenge. Nonetheless, it is important to be aware of the possibility of development of a thyroid storm in patients with a history of subclinical hypothyroidism. In addition, patients, if diagnosed with a thyroid storm, should be treated immediately with appropriate medications since thyrotoxicosis is life threatening.