When the storm passes unnoticed - A case series of thyroid storm

Introduction: Thyroid crisis is an acute manifestation of thyrotoxicosis. Approximately 1-2% of patients progress to a thyroid storm, often precipitated by a physiologically stressful event. If unrecognized or left untreated, thyroid storm may result in cardiovascular collapse and death. Aim: We describe three patients who presented to the Emergency Department of Singapore General. Hospital in a thyroid storm. They had complications of thyrocardiac disease with heart failure and arrhythmias. Methods: An analysis of case records of patients presenting to the emergency department of Singapore General Hospital with a primary diagnosis of thyrotoxicosis was made over the period of 2004-2005. Three patients with thyroid storm were identified. All the patients presented heart failure and cardiac arrhythmias (1 atrial flutter, 2 atria[ fibrillation). Discussion and conclusion: Thyroid storm is a rare manifestation of thyrotoxicosis, usually occuring in females during the third to sixth decades of life. Serious complications such as heart failure and hypotension resulting in cardiovascular cotlapse and death may occur. Our case series consists of young mates presenting with thyrocardiac failure. One patient was treated with beta-blockers and another with calcium channel Mockers. Both developed cardiovascular collapse. The third patient was managed with digoxin with a good outcome. The current pathophysiology and therapeutic options are explored. A high index of suspicion should be maintained in young mates presenting with heart failure and arrhythmia. (c) 2006 Elsevier Ireland Ltd. Alt rights reserved.