Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report
Abstract Background Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00490-4 |
| _version_ | 1797865654685007872 |
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| author | Aimi Ohya Makoto Ohtake Yusuke Kawamura Taisuke Akimoto Masayuki Iwashita Tetsuya Yamamoto Ichiro Takeuchi |
| author_facet | Aimi Ohya Makoto Ohtake Yusuke Kawamura Taisuke Akimoto Masayuki Iwashita Tetsuya Yamamoto Ichiro Takeuchi |
| author_sort | Aimi Ohya |
| collection | DOAJ |
| description | Abstract Background Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital. Case presentation The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient’s symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient’s condition. Conclusion If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient’s condition is critical, and early diagnosis will lead to a favorable outcome for the patient. |
| first_indexed | 2024-04-09T23:11:37Z |
| format | Article |
| id | doaj.art-20f2fd702f554b09b2749d52084e243b |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-04-09T23:11:37Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-20f2fd702f554b09b2749d52084e243b2023-03-22T10:20:26ZengBMCInternational Journal of Emergency Medicine1865-13802023-03-011611610.1186/s12245-023-00490-4Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case reportAimi Ohya0Makoto Ohtake1Yusuke Kawamura2Taisuke Akimoto3Masayuki Iwashita4Tetsuya Yamamoto5Ichiro Takeuchi6Department of Emergency and Critical Care, Yokohama City University Medical CenterDepartment of Emergency and Critical Care, Yokohama City University Medical CenterDepartment of Emergency and Critical Care, Yokohama City University Medical CenterDepartment of Neurosurgery, Yokohama City University Medical CenterDepartment of Emergency and Critical Care, Yokohama City University Medical CenterDepartment of Neurosurgery, Yokohama City University Graduate School of MedicineDepartment of Emergency and Critical Care, Yokohama City University Medical CenterAbstract Background Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital. Case presentation The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient’s symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient’s condition. Conclusion If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient’s condition is critical, and early diagnosis will lead to a favorable outcome for the patient.https://doi.org/10.1186/s12245-023-00490-4Subarachnoid hemorrhageThyroid stormTachycardia |
| spellingShingle | Aimi Ohya Makoto Ohtake Yusuke Kawamura Taisuke Akimoto Masayuki Iwashita Tetsuya Yamamoto Ichiro Takeuchi Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report International Journal of Emergency Medicine Subarachnoid hemorrhage Thyroid storm Tachycardia |
| title | Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report |
| title_full | Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report |
| title_fullStr | Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report |
| title_full_unstemmed | Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report |
| title_short | Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report |
| title_sort | diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm a case report |
| topic | Subarachnoid hemorrhage Thyroid storm Tachycardia |
| url | https://doi.org/10.1186/s12245-023-00490-4 |
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