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Fatal Recurrent Cardioembolic Stroke Related to Thyroid Storm: A Case Report
Chu-Fang Cheng1, Chih-Yang Liu1, Shinn-Kuang Lin1,2
1Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
Acta Neurologica Taiwanica
|December 30, 2025
Summary
Thyroid storm, a severe hyperthyroidism complication, can mimic stroke symptoms. Early diagnosis and simultaneous treatment of thyroid storm and ischemic stroke are critical but challenging, as illustrated by a complex case.
Area of Science:
- Endocrinology
- Neurology
- Cardiology
Background:
- Thyroid storm is a rare, life-threatening endocrine emergency.
- Hyperthyroidism can present with neurological and cardiovascular complications.
- Distinguishing thyroid storm from acute stroke is clinically challenging.
Purpose of the Study:
- To report a case of thyroid storm presenting with stroke-like symptoms.
- To highlight the diagnostic and therapeutic challenges in managing co-existing thyroid storm and ischemic stroke.
- To emphasize the importance of early diagnosis and integrated management.
Main Methods:
- Case report of a 50-year-old woman with a history of hyperthyroidism and atrial fibrillation.
- Clinical presentation of acute left limb weakness and slurred speech.
- Diagnostic workup including ECG, chest radiography, brain CT angiography, laboratory tests (thyroid hormones, TSH receptor antibody), and echocardiography.
- Management involved thrombolytic therapy, digoxin, propranolol, and propylthiouracil.
Main Results:
- Patient presented with symptoms mimicking ischemic stroke.
- Laboratory findings confirmed thyroid storm (elevated FT4, FT3; reduced TSH; positive TSH receptor antibody).
- Despite initial thrombolytic therapy and subsequent management, the patient developed recurrent bilateral hemispheric infarction, leading to coma and quadriplegia.
Conclusions:
- Thyroid storm can present with neurological deficits mimicking acute ischemic stroke.
- Simultaneous management of thyroid storm and ischemic stroke poses significant clinical challenges.
- Prompt diagnosis and integrated therapeutic strategies are crucial for improving outcomes in patients with co-existing conditions.
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