Thyroid storm presenting with coma

Thyroid storm is a rare manifestation of severe thyrotoxicosis, and presentation with coma is highly atypical. A 32-year-old woman, previously euthyroid, presented in a comatose state with tachycardia, hypertension and pyrexia. The patient's trachea was intubated in the community and she was subsequently admitted to the intensive care unit with a working diagnosis of meningoencephalitis. Although hypertension was present initially, subsequent hypotension necessitated a noradrenaline infusion. The patient remained persistently tachycardic and pyrexial. Initial laboratory investigations, including examination of cerebrospinal fluid, did not identify a specific diagnosis. Subsequently, raised thyroxine and triiodothyronine levels alongside undetectable thyroid-stimulating hormone confirmed the diagnosis of thyroid storm. Following treatment for thyrotoxicosis, the patient made a full recovery and was discharged from the intensive care unit after three days. This case highlights the importance of considering thyroid disease in critically ill patients presenting with non-specific symptoms.