World Journal of Endocrine Surgery

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VOLUME 12 , ISSUE 2 ( May-August, 2020 ) > List of Articles

CASE REPORT

Thyroidectomy in a Patient with Thyroid Storm, Severe Dyspnea, and Cardiac Dysfunction

Pedro Yuste Garcia, Monica Galan Martín, Julia Bernal Tirapu, Marta Gutierrez Andreu, Eduardo Ferrero Herrero, Federico Hawkins Carranza

Keywords : Cardiopulmonary failure, Thyroid storm, Thyrotoxicosis, Total thyroidectomy

Citation Information : Garcia PY, Martín MG, Tirapu JB, Andreu MG, Herrero EF, Carranza FH. Thyroidectomy in a Patient with Thyroid Storm, Severe Dyspnea, and Cardiac Dysfunction. World J Endoc Surg 2020; 12 (2):101-104.

DOI: 10.5005/jp-journals-10002-1285

License: CC BY-NC 4.0

Published Online: 16-01-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Thyroid storm (TS) is an endocrine emergency demanding prompt and intensive treatment. Several risk factors are involved in precipitating TS and should be prevented in patients with thyrotoxicosis. Withdrawal of antithyroid drugs is probably the main risk factor for TS. Treatment with oral or intravenous drugs (antithyroid agents, steroids, and iodine) is required. Other measures are needed, such as plasmapheresis, diuretics, supportive care, and management of systemic complications such as cardiorespiratory failure. Finally, precipitating factors must be controlled. Nevertheless, some patients do not respond to therapy and their lives further deteriorate, creating circumstances in which thyroidectomy should be considered. We report the case of a 42-year-old woman with a previous history of thyrotoxicosis, diagnosed 18 years earlier, who was noncompliant with her therapy. Her medication was stopped before she came to our emergency unit with multinodular goiter, severe dyspnea, edema, tachycardia, and malnutrition. Thyroid storm was diagnosed, and she was transferred to the intensive care unit. She was treated with intensive antithyroid drugs, glucocorticoids, iodine solution, a β-blocker drug, and support measures. Due to rapid deterioration of her health in the absence of a reduction in thyroid hormone response, total thyroidectomy was decided. After surgery, the patient was well, with recovery of respiratory function and reduction in thyroid hormone levels. She was discharged with normal parameters. Consequently, if patients with thyroid storm continue to deteriorate despite medical treatment, thyroidectomy should be considered at centers with the necessary expertise.


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