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Thyroid storm and ventricular tachycardia.
Yeun Tarl Fresner Ng Jao1, Yi Chen, Wen-Hung Lee
1Department of Emergency Medicine and the Endocrinology Section, Tainan Municipal Hospital, Tainan, Taiwan.
Southern Medical Journal
|July 17, 2004
Summary
Thyroid storm can cause sudden cardiac arrest due to ventricular tachyarrhythmia, even without prior heart disease. This unusual case highlights a critical, life-threatening presentation of thyroid storm.
Area of Science:
- Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Thyroid storm is a severe, life-threatening exacerbation of thyrotoxicosis.
- Cardiac manifestations are common in thyroid storm, but typically include atrial fibrillation or sinus tachycardia.
Observation:
- A 34-year-old woman presented with sudden loss of consciousness and cardiac arrest.
- Electrocardiographic monitoring revealed ventricular tachycardia and fibrillation, which were initially refractory to defibrillation.
- The patient was diagnosed with thyroid storm, with normalization of fever and tachycardia within 48 hours, but remained comatose and ultimately died.
Findings:
- This case represents the first reported instance of ventricular tachyarrhythmia as the initial presenting sign of thyroid storm.
- The patient had no prior history of cardiac disease, making the cardiac arrest presentation highly unusual.
Implications:
- This case expands the spectrum of cardiac presentations of thyroid storm.
- Clinicians should consider thyroid storm in the differential diagnosis of unexplained ventricular tachyarrhythmias, especially in patients with risk factors for thyroid disease.
- Early recognition and aggressive management of thyroid storm are crucial, even with atypical cardiac presentations.