Hepatic failure resulting from thyroid storm with normal serum thyroxine and triiodothyronine concentrations

A 63-year-old male presented with productive cough, fever, palpitation, shortness of breath, and mental confusion. Fulminant hepatic failure occurred with high aminotransferase and severe jaundice. Thyroid function tests showed thyroid-stimulating hormone level of 0.7 microU/mL (normal range, < 6.2 microU/mL), with normal serum thyroxine and triiodothyronine levels. He died on post-admission day 5. Autopsy revealed diffuse hyperplasia of the thyroid gland, centrilobular necrosis of the liver, and congestion of the gastrointestinal tract, spleen, and adrenal glands. These pathological findings were compatible with decompensated hyperthyroidism. Thyroid storm may present with normal serum triiodothyronine, thyroxine, and hepatic failure. Such presentation is rare.