Thyroid storm caused by a chinese herb contaminated with thyroid hormones

Area of Science:

• Endocrinology
• Integrative Medicine
• Clinical Toxicology

Background:

• Thyroid storm is a severe, life-threatening condition requiring prompt diagnosis and management.
• The use of traditional Chinese medicine (TCM) is widespread, necessitating an understanding of potential herb-drug and herb-herb interactions.
• Contamination of herbal products with undeclared active pharmaceutical ingredients poses a significant public health risk.

Observation:

• A 70-year-old man developed thyroid storm with rapid atrial fibrillation after consuming TCM products.
• The patient required intensive care, cardioversion, and mechanical ventilation.
• Analysis of the TCM product 'Flower Man Sang Hung' revealed contamination with levothyroxine.

Findings:

• The patient's thyroid storm was directly linked to the levothyroxine contamination in the consumed herbal product.
• Prompt identification of the contaminated herb led to the patient's recovery and discharge.
• The case underscores the potential for serious adverse events from adulterated herbal medicines.

Implications:

• Clinicians must maintain a high index of suspicion for iatrogenic causes of thyroid dysfunction, including contaminated supplements.
• Enhanced regulatory oversight and quality control of herbal products are crucial.
• Educating healthcare providers and patients about the risks associated with herbal medicine use is essential for patient safety.