Thyroid storm complicated by metabolic encephalopathy in a young patient: A case report and literature review

Metabolic encephalopathy is a rare but potentially devastating complication of thyroid storm. Its etiology is complex, clinical manifestations are diverse, there is no clear diagnostic criteria, so it is easy to lead to missed diagnosis, misdiagnosis, and mistreatment. We report a case of thyroid storm complicated by metabolic encephalopathy.

A 20-year-old male patient with a history of hyperthyroidism was admitted to the hospital because of limb twitching, foaming at the mouth and coma. The laboratory test results confirmed the diagnosis of thyroid storm. After treatment, the patient's clinical symptoms gradually improved.

The diagnosis was thyroid crisis complicated with metabolic encephalopathy, sepsis, pneumonia, acute kidney damage, liver function impairment, and rhabdomyolysis.

The patient was given 100 mg hydrocortisone intravenously per 8 hours, propylthiouracil tablets of 250 mg q4h by nasal feeding, propranolol of 50 mg q4h by nasal feeding, piperacillin 5 g q8h intravenously, tigecycline 50 mg q12h (the first drug is 100 mg) intravenously, voriconazole 0.2 g q12h intravenously, and continuous kidney replacement therapy.

The patient's vital signs stabilized, his consciousness level improved, and after being taken off the ventilator, he was transferred to the Department of Traditional Chinese Medicine, where he received Chinese medicine and rehabilitation treatment, and was discharged from the hospital after his condition improved.

Thyroid storm complicated by metabolic encephalopathy requires early diagnosis and treatment, and the neurological function damage caused by it is usually reversible.