Endocrine Abstracts

Thyroid storm is rare and life threatening manifestation of thyroid hormone excess. It has high mortality rate with delayed treatment. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance. We present a case of thyroid storm which was different in terms of absence of fever on presentation, presence of thrombocytopenia and deranged cholestatic LFTs which resolved after treatment of thyroid storm. 55 year female with background of Graves’ disease (Treatment stopped in 2016), presented with 4 days history of breathlessness. A week ago she had cough which settled after course of oral antibiotics. She also had history of weight loss and night sweats for last 3 months. On presentation, She was in fast Atrial fibrillation with rate of 240bpm and few beats of Broad complex tachycardia with blood pressure of 90/60 mmhg. She was apyrexial and was in heart failure with bibasal crackles, bilateral pitting oedema, CXR showing bilateral pleural effusion and upper lobe diversion. She appeared cachectic with exophthalmos and proximal myopathy. She had small painless palpable goitre. Burch-Wartofsky Point Scale for diagnosis of thyroid Storm was 60 which prompted treatment in lines of thyroid storm. Later on her thyroid function tests showed raised T3 and T4 with supressed TSH and TBII was raised. After advice from Endocrinologist, she was treated with systemic steroids, beta blockers, high doses of PTU, cholestyramine and diuretics for heart failure. Lugol’s iodine was withheld as she started to improve clinically. She also had raised Transaminases and thrombocytopenia which resolved once the thyroid hormone levels improved. She was planned for inpatient thyroidectomy. She remained apyrexial throughout while fever is thought to be universal in thyroid storm which highlights the fact that storm should be considered even in the absence of fever.