Introduction: Thyroid Storm is a rarely occurring severe form of hyperthyroidism, almost always brought about by precipitating event. It occurs more frequently with Graves disease. The mortality varies from 20 to 50%. The diagnosis of thyroid storm is mainly clinical along with abnormal thyroid hormone levels. We report a case of thyroid storm with chorea as one of its manifestation.
Case report: A fifty year old lady was referred to us for recent onset of unsteadiness of gait and dropping things. Further history revealed loss of weight, diarrhoea and palpitations for the previous five months and General Practitioner had diagnosed hyperthyroidism. She was stared on 15 mg of Carbimazole. Her compliance with the medication was good. She was a current smoker.
On examination, she had all the classical manifestations of hyperthyroidism including Thyroid Acropachy. We observed Chroeatic movements affecting the extremities and neck. There was a diffuse goitre which was minimally tender. Investigations revealed ESR - 35 mm in 1st hour, eosinophil count-0.89×109/L, TSH<0.03 mu/L, Free T4 -76.1 pmol/L, Free T3 38.5 pmol/L. Serum cortisol was normal.
The diagnosis was thyroid storm precipitated by infective thyroiditis (viral). Graves disease is the likely cause of hyperthyroidism. She was treated with Propranolol 40 mg 6th hourly, Carbimazole 60 mg od, Prednisolone 40 mg od and supportive treatment was given. Her symptoms and signs of hyperthyroidism and chorea improved completely in two weeks. The lady was discharged home with an out patient follow up.
Discussion: This case highlights some of the common as well as rare manifestations of thyroid storm. High index of suspicion is important in early diagnosis and management as the mortality is significantly high.