Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis
Introduction: While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza. Case: A 69-year-old dia...
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2016-09-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://www.jchimp.net/index.php/jchimp/article/view/31750/pdf_209 |
| _version_ | 1797970704339042304 |
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| author | Raafia Memon WuQiang Fan Richard Snyder Mahesh Krishnamurthy |
| author_facet | Raafia Memon WuQiang Fan Richard Snyder Mahesh Krishnamurthy |
| author_sort | Raafia Memon |
| collection | DOAJ |
| description | Introduction: While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza. Case: A 69-year-old diabetic female was found by the paramedic staff to be disoriented. She demonstrated tachycardia and had a foul-smelling abdominal wound. Laboratory evaluation revealed DKA, leukocytosis, influenza B, and urinary tract infection. After appropriate management in the intensive care unit, the DKA resolved the following morning. However, the patient developed a fever, and her psychosis became more pronounced. Extensive analysis was performed but did not explain her mental status. The patient was found to have thyroid stimulating hormone of 0.06 mIU/mL, free T4 (thyroxine) of 2.38 ng/dL, and total T3 (triiodothyronine) of 72 ng/dL. Based on the Burch and Wartofsky criteria (score of 65), TS was diagnosed. Based on more recent diagnostic criteria suggested by Akamizu et al., the patient met criteria for TS grade 1. Within several hours of initiating treatment, the patient's mental state and tachycardia improved, and her psychosis resolved by the third day. Conclusion: This case highlights the importance of recognizing the clinical diagnosis of TS, as the magnitude of thyroid hormone derangements may not correlate with clinical severity. While rare, DKA and TS can simultaneously occur and are associated with increased morbidity and mortality if not promptly recognized and treated. |
| first_indexed | 2024-04-11T03:21:13Z |
| format | Article |
| id | doaj.art-3549cbfb35f540f49c4061130ac3f105 |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T03:21:13Z |
| publishDate | 2016-09-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-3549cbfb35f540f49c4061130ac3f1052023-01-02T08:46:23ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662016-09-01641310.3402/jchimp.v6.3175031750Thyroid storm presenting as psychosis: masked by diabetic ketoacidosisRaafia Memon0WuQiang Fan1Richard Snyder2Mahesh Krishnamurthy3Department of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USADepartment of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USADepartment of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USADepartment of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USAIntroduction: While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza. Case: A 69-year-old diabetic female was found by the paramedic staff to be disoriented. She demonstrated tachycardia and had a foul-smelling abdominal wound. Laboratory evaluation revealed DKA, leukocytosis, influenza B, and urinary tract infection. After appropriate management in the intensive care unit, the DKA resolved the following morning. However, the patient developed a fever, and her psychosis became more pronounced. Extensive analysis was performed but did not explain her mental status. The patient was found to have thyroid stimulating hormone of 0.06 mIU/mL, free T4 (thyroxine) of 2.38 ng/dL, and total T3 (triiodothyronine) of 72 ng/dL. Based on the Burch and Wartofsky criteria (score of 65), TS was diagnosed. Based on more recent diagnostic criteria suggested by Akamizu et al., the patient met criteria for TS grade 1. Within several hours of initiating treatment, the patient's mental state and tachycardia improved, and her psychosis resolved by the third day. Conclusion: This case highlights the importance of recognizing the clinical diagnosis of TS, as the magnitude of thyroid hormone derangements may not correlate with clinical severity. While rare, DKA and TS can simultaneously occur and are associated with increased morbidity and mortality if not promptly recognized and treated.http://www.jchimp.net/index.php/jchimp/article/view/31750/pdf_209thyroid stormdiabetic ketoacidosishyperthyroidismthyrotoxicosisdiabetes mellitus |
| spellingShingle | Raafia Memon WuQiang Fan Richard Snyder Mahesh Krishnamurthy Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis Journal of Community Hospital Internal Medicine Perspectives thyroid storm diabetic ketoacidosis hyperthyroidism thyrotoxicosis diabetes mellitus |
| title | Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis |
| title_full | Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis |
| title_fullStr | Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis |
| title_full_unstemmed | Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis |
| title_short | Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis |
| title_sort | thyroid storm presenting as psychosis masked by diabetic ketoacidosis |
| topic | thyroid storm diabetic ketoacidosis hyperthyroidism thyrotoxicosis diabetes mellitus |
| url | http://www.jchimp.net/index.php/jchimp/article/view/31750/pdf_209 |
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