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Thyroid storm in a polytrauma patient.
1United Lincolnshire Hospitals, NHS Trust, Lincoln County Hospital, Greetwell Road, Lincolnshire LN2 5QY, UK. jonnywilkinson@doctors.org.uk
Anaesthesia
|June 13, 2008
Summary
A road traffic accident patient presented with agitated symptoms, later diagnosed with acute thyroid storm. This case highlights the importance of considering thyroid storm in trauma patients with unusual vital signs.
Area of Science:
- Emergency Medicine
- Endocrinology
- Trauma Surgery
Background:
- Road traffic accidents (RTAs) are a significant cause of trauma.
- Thyroid storm is a life-threatening exacerbation of thyrotoxicosis.
Observation:
- A 38-year-old female driver in an RTA presented with agitation, tachycardia, tachypnea, and hypertension (Glasgow Coma Score 14).
- Initial management included an abdominal CT scan, leading to an emergency laparotomy.
- Persisting symptoms and laboratory results indicated acute thyroid storm.
Findings:
- Thyroid Stimulating Hormone (TSH): < 0.10 IU/L
- Free Thyroxine (fT4): 59.8 pmol/L
- Free Triiodothyronine (fT3): 20.20 pmol/L
Implications:
- This case underscores the critical need to consider thyroid storm in trauma patients presenting with atypical signs and symptoms.
- Early recognition and management of thyroid storm are crucial for improving outcomes in critically ill patients.
- Integrated care between trauma surgery and endocrinology is vital for complex cases involving co-existing conditions.
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Assessment:
1. Clinical Evaluation:
History: