A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man
ABSTRACT: Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-01-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520302741 |
| _version_ | 1818723759289270272 |
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| author | Gina M. Mathew, MD Aleida Rodriguez, MD Lima Lawrence, MD Kavita P. Krishnasamy, MD Rajinder S. Marok, MD Sunil Pauwaa, MD Muhyaldeen Dia, MD Gregory P. Macaluso, MD Erin Dana. Drever, MD Tahira Yasmeen, MD, FACE |
| author_facet | Gina M. Mathew, MD Aleida Rodriguez, MD Lima Lawrence, MD Kavita P. Krishnasamy, MD Rajinder S. Marok, MD Sunil Pauwaa, MD Muhyaldeen Dia, MD Gregory P. Macaluso, MD Erin Dana. Drever, MD Tahira Yasmeen, MD, FACE |
| author_sort | Gina M. Mathew, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac involvement is the leading cause of death in patients with thyroid storm. We report a unique case of thyroid storm precipitated by viral myopericarditis in the setting of exogenous thyroid hormone supplementation.Methods: Case report and review of the literature.Results: We report a case of a previously healthy 26-year-old male with a history of bodybuilding who developed thyroid storm with multi-organ failure, including acute-onset congestive heart failure, leading to cardiogenic shock. Investigations revealed ingestion of exogenous thyroid hormone as the source of his thyrotoxicosis. Initial labs revealed serum thyroid-stimulating hormone 0.015 mU/L, free thyroxine 2.3 ng/dL, free triiodothyronine 8.8 pg/mL, total triiodothyronine of 2.22 ng/mL, and thyroglobulin 4.4 ng/mL. There was also evidence of viral myopericarditis, as demonstrated on cardiac imaging and multiple elevated Coxsackie virus B titer levels.Conclusion: Given the patient's underlying thyrotoxic state from exogenous thyroid hormone ingestion, we believe that his acute myopericarditis was the catalyst that precipitated his thyroid storm. The combination of acute myopericarditis and thyroid storm ultimately led to cardiogenic shock. He showed rapid improvement with cardiopulmonary supportive efforts and treatment for thyroid storm. In considering the etiology of thyroid storm, it is important to exclude the possibility of exogenous thyroid hormone ingestion, especially in the setting of nonregulated, over-the-counter, bodybuilding, or weight-loss supplement use.Abbreviations: MRI = magnetic resonance imaging; SSKI = supersaturated potassium iodide; T3 = triiodothyronine; T4 = thyroxine |
| first_indexed | 2024-12-17T21:15:37Z |
| format | Article |
| id | doaj.art-c56818506d80441aa3c3c9028a9b8d44 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-17T21:15:37Z |
| publishDate | 2017-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-c56818506d80441aa3c3c9028a9b8d442022-12-21T21:32:22ZengElsevierAACE Clinical Case Reports2376-06052017-01-0131e74e78A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular ManGina M. Mathew, MD0Aleida Rodriguez, MD1Lima Lawrence, MD2Kavita P. Krishnasamy, MD3Rajinder S. Marok, MD4Sunil Pauwaa, MD5Muhyaldeen Dia, MD6Gregory P. Macaluso, MD7Erin Dana. Drever, MD8Tahira Yasmeen, MD, FACE9From the University of Illinois at Chicago, Department of Endocrinology, Chicago, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, Illinois; Address correspondence to Dr. Lima Lawrence, UIC–Advocate Christ Medical Center, Department of Internal Medicine, 4440 West 95th Street, Oak Lawn, Illinois 60453.UIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisAdvocate Illinois Masonic Medical Center, Chicago, Illinois.UIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisUIC–Advocate Christ Medical Center, Department of Internal Medicine, Oak Lawn, IllinoisABSTRACT: Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac involvement is the leading cause of death in patients with thyroid storm. We report a unique case of thyroid storm precipitated by viral myopericarditis in the setting of exogenous thyroid hormone supplementation.Methods: Case report and review of the literature.Results: We report a case of a previously healthy 26-year-old male with a history of bodybuilding who developed thyroid storm with multi-organ failure, including acute-onset congestive heart failure, leading to cardiogenic shock. Investigations revealed ingestion of exogenous thyroid hormone as the source of his thyrotoxicosis. Initial labs revealed serum thyroid-stimulating hormone 0.015 mU/L, free thyroxine 2.3 ng/dL, free triiodothyronine 8.8 pg/mL, total triiodothyronine of 2.22 ng/mL, and thyroglobulin 4.4 ng/mL. There was also evidence of viral myopericarditis, as demonstrated on cardiac imaging and multiple elevated Coxsackie virus B titer levels.Conclusion: Given the patient's underlying thyrotoxic state from exogenous thyroid hormone ingestion, we believe that his acute myopericarditis was the catalyst that precipitated his thyroid storm. The combination of acute myopericarditis and thyroid storm ultimately led to cardiogenic shock. He showed rapid improvement with cardiopulmonary supportive efforts and treatment for thyroid storm. In considering the etiology of thyroid storm, it is important to exclude the possibility of exogenous thyroid hormone ingestion, especially in the setting of nonregulated, over-the-counter, bodybuilding, or weight-loss supplement use.Abbreviations: MRI = magnetic resonance imaging; SSKI = supersaturated potassium iodide; T3 = triiodothyronine; T4 = thyroxinehttp://www.sciencedirect.com/science/article/pii/S2376060520302741 |
| spellingShingle | Gina M. Mathew, MD Aleida Rodriguez, MD Lima Lawrence, MD Kavita P. Krishnasamy, MD Rajinder S. Marok, MD Sunil Pauwaa, MD Muhyaldeen Dia, MD Gregory P. Macaluso, MD Erin Dana. Drever, MD Tahira Yasmeen, MD, FACE A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man AACE Clinical Case Reports |
| title | A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man |
| title_full | A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man |
| title_fullStr | A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man |
| title_full_unstemmed | A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man |
| title_short | A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man |
| title_sort | unique presentation of thyroid storm and myopericarditis in a young muscular man |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520302741 |
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