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Eur Heart J Case Rep 2022 May 4;6(5):ytac197. Epub 2022 May 4.

Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shimmachi, 564-8565 Suita, Osaka, Japan.

Background: Thyroid storm (TS) complicated by cardiogenic shock is associated with high mortality due to the high incidence of multiple organ failure. It is recommended that TS patients with hepatic failure undergo plasma exchange (PE) and receive optimal anti-hyperthyroid medications. However, the effect of PE on cardiac dysfunction in TS patients has been unclear. Read More

BMJ Case Rep 2022 May 12;15(5). Epub 2022 May 12.

Cardiology, Northern Hospital Epping, Epping, Victoria, Australia.

A woman in her 50s with a background of chronic obstructive pulmonary disease secondary to smoking presented with intermittent chest tightness, dyspnoea and vomiting for 4 days. A presumed diagnosis of acute coronary syndrome (ACS) was made based on dynamic ischaemic ECG changes and elevation in high-sensitivity cardiac troponin T levels. She underwent emergent coronary angiography which demonstrated mild coronary artery disease with left ventriculography suggestive of mid-wall variant Takotsubo cardiomyopathy. Read More

Am J Case Rep 2022 Apr 28;23:e935789. Epub 2022 Apr 28.

Division of Endocrinology, Diabetes and Metabolism, Parkview Medical Center, Pueblo, CO, USA.

BACKGROUND The therapeutic approach to Graves' disease (GD) comprises thionamides, radioiodine ablation, or surgery as first-line therapy, and cholestyramine and oral iodine as second-line therapies. The role of lithium (Li) in GD as a primary or adjunctive therapy remains contentious. We present a case of GD managed by Li therapy with oral iodine solution. Read More

Travel Med Infect Dis 2022 May-Jun;47:102314. Epub 2022 Mar 18.

Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey. Electronic address:

COVID-19 is a severe acute respiratory syndrome. Recent reports showed that autoimmune thyroiditis might occur following COVID-19 infection. We aimed to review the literature to assess the prevalence, clinical features and outcome of autoimmune thyroid disorders triggered by COVID-19. Read More

FP Essent 2022 Mar;514:11-17

Department of Family Medicine - College of Medicine - Medical University of South Carolina, 135 Cannon St Suite 405 MSC 192, Charleston, SC 29425.

Hyperthyroidism is an excess in thyroid hormone production caused by such conditions as Graves disease, toxic multinodular goiter, and toxic adenoma. Overt hyperthyroidism is defined as a low or undetectable thyrotropin (TSH) level with elevated triiodothyronine (T) or thyroxine (T) values, whereas subclinical hyperthyroidism is defined as low or undetectable TSH with normal T and T levels. Symptoms of hyperthyroidism include nervousness, heat intolerance, weight loss, and fatigue. Read More

J Int Med Res 2022 Feb;50(2):3000605221082898

Associate Professor of Medicine and Endocrinology, Department of Clinical Science, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.

In this review, I aim to provide a complete overview of recent advances in knowledge regarding severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-induced thyroid dysfunction. I discuss the findings regarding the role of SARS-CoV-2 in the development of thyroid dysfunction, including subacute thyroiditis, Graves' disease, non-thyroidal illness, thyrotoxicosis and Hashimoto's thyroiditis during and subsequent to coronavirus disease 2019 (COVID-19). The thyroid gland and the entire hypothalamic-pituitary-thyroid (HPT) axis may represent key targets of SARS-CoV-2. Read More

Cureus 2022 Jan 9;14(1):e21048. Epub 2022 Jan 9.

Internal Medicine, Jamaica Hospital Medical Center, New York, USA.

Thyroid storm is a rare but life-threatening condition that can occur in the setting of incompletely treated or untreated hyperthyroidism, and is often precipitated by recent infection, surgery, or trauma. We present a fascinating case report of the successful stabilization of a 29-year-old female, recently diagnosed with hyperthyroidism and non-compliant with medications, who presented with thyroid storm in the setting of sepsis secondary to right-sided pyelonephritis, non-ST-segment elevation myocardial infarction (NSTEMI) type 2, and hyperbilirubinemia. Management was further complicated by electrolyte imbalances secondary to severe diarrhea due to the thyroid storm and pancytopenia likely due to aggressive hydration. Read More

Cureus 2021 Dec 30;13(12):e20840. Epub 2021 Dec 30.

Medical Education/ Internal Medicine, Endocrine and Diabetes, Hamad Medical Corporation, Doha, QAT.

Hyperthyroidism primarily presents with the symptoms and signs of thyrotoxicosis. However, many cases might present with a precipitating factor that unmasks the hyperthyroid status of the patients. These factors are associated with a stress condition, with infections being the most common factors, diabetic ketoacidosis, acute coronary syndrome, and pulmonary embolism. Read More

AACE Clin Case Rep 2022 Jan-Feb;8(1):2-5. Epub 2021 Jun 11.

Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore.

Objective: Thyrotoxicosis from local invasion of the thyroid gland by an extrathyroidal malignancy is rare. We describe a patient with thyrotoxicosis secondary to invasion of the thyroid gland by an oropharyngeal squamous cell carcinoma (OPSCC). To our best knowledge, this has not been reported. Read More

J Inflamm Res 2021 24;14:6191-6221. Epub 2021 Nov 24.

Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.

Coronavirus disease-2019 (COVID-19) is asymptomatic in most cases, but it is impartible and fatal in fragile and elderly people. Heretofore, more than four million people succumbed to COVID-19, while it spreads to every part of the globe. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) induces various dysfunctions in many vital organs including the thyroid by utilizing ACE2 as a receptor for cellular entry. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211056497

UT Southwestern Medical Center, Dallas, USA.

Since the start of the COVID-19 pandemic, there have been multiple reports of related thyroid dysfunction, most commonly, thyroiditis. The exact mechanism for this has not been elucidated, but it is known that thyroid gland cells have both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) receptors, which the SARS-CoV-2 virus uses to enter cells. While SARS-CoV-2 has also been shown to precipitate other autoimmune diseases, there are only a few reported cases of new onset Graves' disease in the setting of SARS-CoV-2 infection. Read More

Caspian J Intern Med 2021 ;12(Suppl 2):S371-S375

Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Italy.

Background: Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis and can be precipitated by several factors. We described a thyroid storm precipitated by a long-term treatment using homeopathic medicine containing iodine.

Case Presentation: A 55-year-old Italian woman was admitted to our Sub-Intensive Care Unit with the diagnosis of congestive heart failure and thyrotoxicosis. Read More

Am J Case Rep 2021 Nov 6;22:e933751. Epub 2021 Nov 6.

Department of Anesthesiology and Perioperative Medicine, Penn State University College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.

BACKGROUND Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening endocrine emergency that presents with multisystem involvement. Patients present with pronounced signs of hyperthyroidism, fever, tachycardia, and differing severities of multisystem dysfunction and decompensation. Early recognition and prompt initiation of treatment are important. Read More

J Cerebrovasc Endovasc Neurosurg 2021 Oct 26. Epub 2021 Oct 26.

Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.

Moyamoya syndrome (MMS) associated with hyperthyroidism, such as Graves' disease, is a rare condition that causes ischemic stroke with thyrotoxicity. A 43-year-old woman with symptoms of right hemiparesis was admitted. Brain magnetic resonance imaging revealed a small cerebral infarction in the left frontal lobe. Read More

Cureus 2021 Sep 7;13(9):e17786. Epub 2021 Sep 7.

Internal Medicine, CMH Institute of Medical Sciences, Bahawalpur, PAK.

Atrial fibrillation as an initial presenting symptom of an apathetic thyroid storm is under-reported, especially in the setting of undiagnosed hyperthyroidism. Very rarely, thyroid storm can present with apathetic symptoms. The author presents a case of apathetic thyrotoxicosis with atrial fibrillation. Read More

Cardiol Young 2022 Jun 18;32(6):988-992. Epub 2021 Oct 18.

Department of Pediatrics, Children's of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS, USA.

We report a case of thyroid storm precipitated by SARS-CoV-2 infection in an adolescent girl with a history of Graves disease and dilated cardiomyopathy. This case highlights that SARS-CoV-2 infection can potentially trigger a thyrotoxicosis crisis and acute decompensated heart failure in a patient with underlying thyroid disease and myocardial dysfunction even in the absence of multi-system inflammatory syndrome in children. We systematically reviewed the thyrotoxicosis cases with SARS-CoV-2 infection and described its impact on pre-existing dilated cardiomyopathy. Read More

Ann Palliat Med 2021 Sep;10(9):9640-9649

Department of Endocrinology, The First Affiliated Hospital of Chengdu Medical College, Xindu District, Chengdu, China.

Background: This trial aimed to analyze the relationship between hyperthyroidism and the morbidity rate of hypercalcemia in the Xindu district, Chengdu, Sichuan province. We observed the level of serum calcium, the bone metabolic and thyroid autoimmune-related antibodies index during vitamin D3 treatment combined with traditional antithyroid drugs (ATD).

Methods: Our research included hyperthyroid patients with a first-time diagnosis of Graves diseases (GD) combined with hypercalcemia on the basis of conventional anti-hyperthyroidism therapy, which were randomized into a vitamin D3 group (vitamin D3, 800-1,200 IU/day) and an ATD group (methimazole, 15-30 mg/day). Read More

Eur Heart J Case Rep 2021 Aug 16;5(8):ytab270. Epub 2021 Aug 16.

Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy.

Background: Takotsubo syndrome (TTS) is a transient left ventricular dysfunction usually with apical akinesia (classical pattern). Other less frequent variants have been described: the mid-ventricular pattern is characterized by hypokinesia of the mid-left ventricle and hypercontractile apical and basal segments; the inverted or basal pattern is characterized by basal and mid-ventricular segment hypokinesia or akinesia with preserved contractility or hypercontractility of apical segments and finally the focal pattern. There are also biventricular variants and forms with exclusive involvement of the right ventricle. Read More

J Clin Apher 2021 Oct 17;36(5):759-765. Epub 2021 Jul 17.

Internal Medicine Department, Endocrinology and Metabolism Section, School of Medicine, Universidad de Antioquia, Medellin, Colombia.

Background And Aims: Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first-line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second-line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.

Methods: We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. Read More

Am J Med 2021 11 29;134(11):e557-e558. Epub 2021 Jun 29.

Consultant, Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore; Assistant Professor, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Anesth Prog 2021 06;68(2):114-116

Department of Anesthesiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan.

The incidence of childhood-onset Basedow's (Graves') disease is approximately 5% of all cases. Herein, we report a teenage female patient diagnosed with childhood-onset Graves' disease immediately following general anesthesia. Her signs and symptoms included tachycardia immediately prior to general anesthesia, delirium upon emerging from anesthesia, persistent postoperative tachycardia and anxiety, and prolonged nausea and vomiting. Read More

J Pediatr Endocrinol Metab 2021 Sep 24;34(9):1197-1200. Epub 2021 Jun 24.

Department of Pediatrics, Teine Keijinkai Hospital, Sapporo, Japan.

Objectives: Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves' disease. Read More

BMJ Case Rep 2021 Jun 15;14(6). Epub 2021 Jun 15.

Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan.

Simultaneous occurrences of diabetic ketoacidosis (DKA) and thyroid storm have long been known, but only a few cases have been reported to date. Both these endocrine emergencies demand timely diagnosis and management to prevent adverse outcomes. Due to the similarities in their clinical presentation, DKA can mask the diagnosis of thyroid storm and vice versa. Read More

Biopsychosoc Med 2021 May 27;15(1):11. Epub 2021 May 27.

Department of Psychiatry, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.

Background: Graves' disease is characterized by hyperthyroidism and its symptoms often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions. In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.

Case Presentation: We encountered a 34-year-old woman in whom thyroid crisis from Graves' disease was misdiagnosed as panic attack. Read More

Int J Gen Med 2021 3;14:1641-1646. Epub 2021 May 3.

Department of Endocrinology and Metabolism, Zhejiang University Affiliated Sir Run Run Shaw Hospital, School of Medicine, Hangzhou, People's Republic of China.

Introduction: In recent years, radioactive iodine (RAI) therapy has become a main choice for Graves' disease. The rapid release of thyroid hormones following RAI may on occasion trigger severe events, such as thyroid storm or heart block. This study presents two cases of possible acute adrenocortical insufficiency precipitated by radioiodine therapy. Read More

Cureus 2021 Apr 3;13(4):e14271. Epub 2021 Apr 3.

Internal Medicine, Salmaniya Medical Complex, Manama, BHR.

Hyperthyroidism is a common disease. Thyroglossal duct cysts are also a very common type of congenital anomalies. Their co-existence is, however, rare with only a few cases described in the literature of the same. Read More

Cureus 2021 Feb 6;13(2):e13167. Epub 2021 Feb 6.

Cardiology, University of Maryland Prince George's Hospital Center, Cheverly, USA.

The following case involves a 62-year-old female patient suffering from heart failure with reduced ejection fraction (HFrEF) secondary to non-ischemic cardiomyopathy and Graves disease, who developed ventricular fibrillation (VF) after discontinuation of methimazole in preparation for radioiodine ablation. Electrocardiogram (ECG) showed a severely prolonged QTc in the setting of thyrotoxicosis, which significantly improved with high dose methimazole. VF secondary to thyrotoxicosis has rarely been reported and the literature review shows scarce data on its mechanism. Read More

BMC Cardiovasc Disord 2021 03 4;21(1):124. Epub 2021 Mar 4.

Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, 1-1-1 Hiyoshidai, Tomisato, Chiba, 286-0201, Japan.

Background: Thyroid storm (TS) is a rare but potentially life-threatening sequelae of untreated or undertreated hyperthyroidism. While TS frequently causes high-output heart failure, low-output heart failure related to dilated cardiomyopathy (DCM) is extremely rare. Tachycardia is a common clinical presentation of TS, and β1-selective blockers are the first-line agents for treating TS-associated tachycardia. Read More

Ther Apher Dial 2021 Dec 19;25(6):877-883. Epub 2021 Mar 19.

Marmara University School of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey.

Antithyroid drugs (ATDs) are the mainstay of treatment for Graves' disease with possible detrimental adverse effects. Surgery or radioactive iodine (RAI) ablation is the second choice among the treatment options in cases of non-remission. Normalization of serum thyroid hormone levels as much as possible is required before surgery or RAI to prevent thyrotoxic crisis in patients with uncontrolled Graves' disease. Read More

Nihon Ronen Igakkai Zasshi 2021 ;58(1):158-163

Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences.

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. Read More