Thyroid storm after coronary artery bypass surgery: a case report

Area of Science:

• Endocrinology
• Cardiovascular Surgery

Background:

• Thyroid storm is a critical condition often triggered by trauma or infection, but irregular antithyroid drug use is a leading cause.
• Thyroid storm following coronary artery bypass graft (CABG) surgery, particularly presenting as high-output heart failure with extreme tachycardia, is exceptionally rare.

Observation:

• A 74-year-old woman with a history of discontinuing antithyroid medication developed severe tachycardia post-CABG, indicative of thyroid storm.
• Treatment with high-dose steroids was initiated for intractable tachycardia unresponsive to beta-blockers, alongside antibiotic therapy for presumed infection.

Findings:

• Despite interventions, the patient's condition deteriorated, leading to multiple organ failure and death on postoperative day 8.
• This case highlights the severe risks associated with thyroid storm in the context of CABG surgery.

Implications:

• Preoperative optimization to achieve a euthyroid state is crucial for patients with a history of thyroid disease undergoing CABG.
• Anticipating and preparing for thyroid storm management in high-risk patients can potentially improve postoperative outcomes.