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Cardiac abnormalities may be the dominant manifestations of severe hyperthyroidism
The background of the study. The spectrum of hyperthyroidism is broad, varying from no symptoms to severe, life-threatening hyperthyroidism (thyroid storm). This report describes three men with thyroid storm whose illness was dominated by cardiac symptoms and signs.
Case 1. A 32-year-old man had a one-week history of shortness of breath, leg swelling (edema), tremor, and heat intolerance. Physical examination revealed a rapid heart rate (134 beats/min), thyroid enlargement (goiter), and edema. He was hospitalized and treated with propranolol. Four hours later, he had chest discomfort and became breathless, with low blood pressure, continued rapid heart rate, rapid breathing, sweating, and flushing. Chest x-ray showed severe lung congestion, and echocardiography poor cardiac contractility. He was treated for hyperthyroidism and congestive heart failure. He improved and was discharged nine days later.
Case 2. A 28-year-old man had a 1-week history of shortness of breath and generalized fluid retention. Physical examination revealed a rapid heart rate (170 beats/min), congestion of the lungs, and leg edema. Electrocardiography showed atrial fibrillation, and chest x-ray cardiomegaly, lung congestion, and fluid around the right lung. He was hospitalized and treated with several drugs to improve cardiac function, but had recurrent tachycardia and low blood pressure, and then collapsed. Despite additional treatment for heart failure and hyperthyroidism, he died on the ninth hospital day.
Case 3. A 30-year-old man was hospitalized for evaluation of fever and shortness of breath of two days’ duration. He had a poor appetite, weight loss, diarrhea, and heat intolerance for two months. He had a history of hyperthyroidism, and had taken an antithyroid drug until seven months earlier. Physical examination revealed a sick-appearing, anxious man with a heart rate of 143 beats/min, high blood pressure, prominent eyes, goiter, pulmonary congestion, and edema. His heart was enlarged, and he had fluid around both lungs. He was treated with a diuretic drug, an antithyroid drug, and antibiotics. He improved rapidly and was discharged six days later.
The conclusions of the study. Cardiac rhythm abnormalities and heart failure may be the major manifestations of thyroid storm in young patients.
The original article. Ngo SY, Chew HC. When the storm passes unnoticed—a case series of thyroid storm. Resuscitation 2007;73:485-90.
 Next Article: Major cardiac events are common after recovery from hyperthyroidism caused by amiodarone |
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
