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Should we revisit anticoagulation guidelines during thyroid storm?

Andrew W Petersen, Gisela D Puig-Carrión, Angel López-Candales

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    This summary is machine-generated.

    Thyroid storm can cause dangerous heart problems like atrial fibrillation and clots. This case highlights the risk of left atrial appendage clots in thyroid storm patients with cardiomyopathy.

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    Area of Science:

    • Cardiology
    • Endocrinology
    • Thrombosis

    Background:

    • Thyroid storm, a severe thyrotoxicosis manifestation, presents significant cardiovascular risks including heart failure and atrial fibrillation.
    • The role of anticoagulation in preventing thromboembolic events in thyrotoxic atrial fibrillation remains incompletely understood.
    • Cardiac thrombus formation is a recognized complication, yet its management in thyroid storm is not well-defined.

    Observation:

    • A patient with new-onset dilated cardiomyopathy and resistant atrial fibrillation during thyroid storm was observed.
    • The patient presented with a large left atrial appendage clot.
    • This clinical scenario underscores the potential for severe embolic complications.

    Findings:

    • Thyroid storm is associated with a high risk of cardiac thrombus, particularly in the left atrial appendage.
    • The presence of dilated cardiomyopathy and resistant atrial fibrillation exacerbates this risk.
    • This case emphasizes the need for careful evaluation of thromboembolic risk in thyroid storm.

    Implications:

    • Further research is warranted to clarify the optimal anticoagulation strategies for patients with thyroid storm and atrial fibrillation.
    • Clinicians should maintain a high index of suspicion for cardiac thrombus in patients with thyroid storm and cardiovascular complications.
    • This case contributes to the understanding of rare but severe thromboembolic sequelae in thyrotoxicosis.