Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2007) 13 P294

SFEBES2007 Poster Presentations Thyroid (51 abstracts)

Thyroid storm precipitated by trauma: a rare presentation with right heart failure and liver dysfunction

Jeevan Joseph Mettayil & Kamal Abouglila

University hospital of North Durham, Durham, United Kingdom.

Thyroid storm is a rarely seen complication of Thyrotoxicosis complicated by multiple organ dysfunctions. Early recognition is crucial in reducing morbidity and mortality. We present the case of a young lady admitted with traumatic fracture of Tibia and Fibula. She was noted to be in rapid AF and on examination manifested signs of Thyrotoxicosis with palpable goitre. She was noted to be hyperthermic and emotionally labile and confused with signs of right heart failure.Investigations revealed FT3 30.8, FT4 94.3, and TSH undetectable. Liver tests were abnormal with GGT of 190 and ALP of 318.She was treated with high dose Propylthiouracil, aqueous iodine, hydrocortisone, beta blockers and diltiazem. Echocardiogram confirmed right heart failure with dilated RV.

A subsequent isotope uptake scan was consistent with Grave’s disease.

She improved clinically and biochemically with resolution of heart failure and is currently planned for Radioiodine treatment but still remains in AF.

Thyroid storm remains a complication rarely seen but even more interesting features in our case are that storm precipated by trauma is seldom reported{only 5 cases in English literature so far}.Liver dysfunction and reversible right heart failure are uncommon manifestations of Thyrotoxic crisis. This case highlights uncommon precipitants of Thyrotoxic crisis with unusual complications. Early recognition and prompt antithyroid therapies attenuated organ dysfunction helping this patient to recover fully.

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