Case report: A 56-year-old woman admitted to emergency department with fever, dyspnea, productive cough, palpitations, diffuse myalgia, and malasia. Physical examination revealed an anxious-appearing woman with fine tremor in the hands. Her pulse was 140 beats/minute and irregular; blood pressure, 140/90 mmHg; temperature 38.6 °C, respiratory rate 40 breaths per min, and oxygen saturation 91% without supplemental oxygen. In auscultation, bilaterally rales and bronchial breath sounds were heard. Chest radiography at admission showed bilaterally patchy pneumonia. The leukocyte count was 3.400/μl with 45% polymorphonuclear cells, 50% lymphocytes and 5% monocytes. In physical examination, her thyroid gland was enlarged diffusely and non tender. Electrocardiogram showed a trial fibrillation with a rapid ventricular response. Because of her symptoms and the findings on the physical examination, laboratory tests for thyroid function were done. The test revealed a decreased level of thyroid-stimulating hormone, an elevated level of free thyroxine, and free triiodothyronine. The patients condition continued to worsen, and she was admitted to the intensive care unit for further evaluation and management. Propylthiouracil, propranolol, and supportive therapy were started. Nasopharyngeal-swab samples were taken for influenza H1N1 virus. On day 4 of admission, samples were positive for influenza H1N1 virus by PCR. No other organisms were detected from blood, urine or respiratory tract. A 5 days course of oseltamivir was added to the therapy. The diagnosis was thyroid storm accompanied by H1N1 influenza infection. After 12 days, patients levels of thyroid hormones had decreased, vital signs returned to completely normal.
Conclusion: Thyroid storm is a rare and life- threatening endocrinologic emergency that may be precipitated by trauma, surgery, systemic illness, particularly infection and sepsis. We think that, our patient highlights the potential impact of H1N1 influenza infection for thyrotoxic patients.