Endocrine Abstracts

Introduction : In the spectrum of endocrine emergencies, thyroid storm is one of the most critical complications. Recognition and appropriate management of life-threatening thyrotoxicosis is vital to prevent the high morbidity and mortality that may accompany this disorder. The incidence of thyroid storm has been noted to be less than 10% of patients hospitalized for thyrotoxicosis; however, the mortality rate secondary to thyroid storm ranges from 20 to 30%. We report in this work, the case of a patient with unknown Grave disease, who had a thyreotoxicosis storm after cholestectomy.

Observation: 52-year-old patient, 20 days before his thyrotoxicosis storm, our patient presented with acute pancreatitis on vesicular lithiasis, which required the realization of a cholecystectomy, our patient did not show any clinical sign of thyrotoxicosis before surgery, but the occurrence of a hypertensive peak, tachycardia at 147 beats/min and significant dyspnea, a thyroid assessment was carried out, returning in favour of hyperthyroidism with a TSH level < 0.01µui/ml and an FT4 level: 69 pmol/l, the electrocardiogram found an atrial fibrillation, the diagnosis of a thyroid storm was retained on clinical and biological criteria (scored at 50 according to the Wartofsky score) and the patient was transferred to an intensive care unit, where he received appropriate management. Subsequently, our patient received radical treatment for his hyperthyroidism.

Conclusion: Thyrotoxicosis and thyroid storm represent a critical diagnostic and therapeutic challenge to the clinician. Recognition of life-threatening thyrotoxicosis and prompt use of medications aimed at halting the thyrotoxic process at every level is essential to successful management. A set of therapeutic weapons exist: the treatment aimed at stopping synthesis of new hormone within the thyroid gland, halting the release of stored thyroid hormones from the thyroid gland, preventing conversion of T4 to T3, and providing systemic support of the patient. All of which can stop the thyroid storm and save the patient from critical complications. Once this transition occurs, definitive therapy of thyrotoxicosis can be planned.