A delayed diagnosis of thyroid storm in an elderly patient: A case report

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  • Masuda Shiho
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Yoshida Sumiko
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Kudo Chiaki
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Tsujimoto Yoshimi
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Yasui Saya
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Endo Furi
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Mitsui Yukari
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Kurahashi Kiyoe
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Endo Itsuro
    Department of Endocrinology and Metabolism, Tokushima University Hospital
  • Todoroki Takafumi
    Department of Cardiovascular Medicine, Tokushima University Hospital
  • Abe Masahiro
    Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences

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  • 診断に時間を要した高齢者の甲状腺クリーゼの1例
  • シンダン ニ ジカン オ ヨウシタ コウレイシャ ノ コウジョウセン クリーゼ ノ 1レイ

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Abstract

<p>A 70-year-old woman was hospitalized for diarrhea, vomiting, loss of appetite, fatigue, and dyspnea on exertion for the past 3 weeks and treated with intravenous fluid for dehydration. She was receiving prednisolone for polymyositis. She did not have a history of thyroid disease. On day 4 of hospitalization, the patient was diagnosed with congestive heart failure and tachycardiac atrial fibrillation, and treatment with a diuretic agent was initiated. On day 7 of hospitalization, a clinical laboratory evaluation revealed that the level of free thyroxine was 9.95 ng/dL, free triiodothyronine was >30 pg/mL, and thyroid-stimulating hormone was <0.01 μU/mL, and the patient was initially diagnosed with thyrotoxicosis because of Graves' disease. She showed restlessness and had a fever of 39 °C, tachycardia of ≥140 beats/min, pulmonary edema, and frequent diarrhea, all of which were consistent with the symptoms of thyroid storm. Her general condition gradually improved with comprehensive treatment of thyroid storm comprising thiamazole, potassium iodide, hydrocortisone, and landiolol. A reassessment revealed that the patient had already had thyrotoxicosis and thyroid storm on admission. Thyroid storm is a potentially fatal disease that must be urgently addressed; however, its symptoms are difficult to distinguish from those caused by other diseases. Furthermore, elderly individuals may not exhibit typical symptoms of thyroid storm, so the diagnosis is difficult. In this case, the diagnosis was delayed because of the absence of typical symptoms of thyroid storm and the influence of a pre-existing medical condition and medication.</p>

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