Endocrine Abstracts

JOINT1980

Thyroid storm is a rare, life-threatening condition characterized by severe thyrotoxicosis. Common triggers include infection, trauma, surgery, iodine exposure, discontinuation of antithyroid medications. The Burch-Wartofsky criteria, assessing cardiovascular, gastrointestinal, CNS disorders and hyperpyrexia, is frequently used for diagnosis. An 18-year-old male was admitted to the Emergency Department with nausea, vomiting, four-limb paralysis and inability to speak, following ten-days of diarrhea. He was lethargic, febrile (38.5°C), tachycardic, and tachypneic. Neurology consultation was requested for paralysis and speech disturbance, and brain imaging ruled out other diagnoses. A lumbar puncture was performed to investigate CNS infection, but findings were negative. A psychiatric consultation excluded conversion disorder. Thyroid function tests revealed thyrotoxicosis (table 1). Burch-Wartofsky score of 65 confirmed thyroid storm. Treatment was initiated with propylthiouracil (PTU), hydrocortisone, Lugol’s solution and propranolol. Ultrasound revealed thyroid inferno. Intensive antithyroid therapy led to significant increase in liver function tests, resulting in the discontinuation of PTU and the initiation of lithium treatment. After achieving euthyroidism, the patient underwent total thyroidectomy and started on thyroxine replacement therapy. The patient was clinically stable and discharged with plan for close follow-up. Central nervous system findings in thyroid storm may include neurological symptoms such as tremor, hyperreflexia, myopathy and seizures as well as psychiatric symptoms like anxiety, agitation, psychosis and delirium. Paralysis is a rare presentation. While hypokalemic periodic paralysis is one possibility, similar findings can occur in normokalemic patients. The sudden onset of the condition should be considered in differential diagnosis as it may lead to severe outcomes depending on the severity of muscle involvement. Early diagnosis and appropriate treatment can prevent complications and improve prognosis. Controlling thyroid function is crucial in managing this condition and preventing recurrence of paralysis.

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