Endocrine Abstracts

Introduction: Thyroid storm is a potentially fatal disorder if treatment is not initiated promptly upon assessment at the emergency department (ED).

Case: A 20-year-old young woman is referred to the ED with rapid acceleration of complaints of palpitations, fever, diarrhoea and agitation, which had been present since several weeks.

On physical examination we saw an uncomfortable, restless woman with a tachycardia of 170/min, and a fever of 38.5°C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. ECG showed an Atrial Flutter of 150/min. Initial laboratory results showed an ESR of 35 mm/h (0–20 mm/h) and urine analysis tested positive for ketones.

We presumed the patient was suffering from a thyroid storm for which we promptly started treatment at the ED with propranolol and thiamazole.

The next day she was diagnosed with graves disease. Lab results showed a TSH of <0.01 mIU/l (0.4–4.0 mIU/l) and a free T4 of >75 pmol/l (10–22 pmol/l).

Discussion: Thyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is extremely high (90%) if early diagnosis is not made and the patient is left untreated.

Therefore it is critical in case of clinical suspicion for Thyroid storm to start prompt treatment with beta blockade and thiamazole before the diagnosis can be confirmed biochemically.

Conclusion: - Recognition of thyroid storm can be challenging, especially if there are no clues on physical examination.

- Prompt treatment of thyroid storm is vital for outcome.

- Definitive diagnosis of thyroid storm can only be made after treatment has been started.