Background: Thyrotoxicosis, though commonly encountered in endocrinology practice in
Nigeria, seldom presents solely as thyroxine (T4) toxicosis. Thyroid storm, a known life-threatening complication of thyrotoxicosis, can be precipitated by myriad factors. Fine need aspiration for cytology is not known, and has not been previously reported (to the
best of our knowledge) to precipitate thyroid storm.
Case Presentation: The case described is that of a 55 year old woman who presented with
a neck swelling and features of hyperthyroidism, with biochemical parameters in keeping
with T4 toxicosis. Investigating the patient necessitated a fine needle aspiration of the
thyroid swelling. The patient thereafter developed hyper-metabolic features, and
subsequently progressed to confusion and loss of consciousness few hours following the
procedure. Close monitoring and medical management with anti-thyroid and other
supportive therapies, resulted in an improved clinical condition.
Conclusion: T4 toxicosis is a distinct biochemical entity of clinical significance.
Physicians should bear in mind that micro-trauma from an investigation such as fine
needle aspiration of the thyroid gland can tilt a thyrotoxic patient into thyroid storm, and
this risk should be considered and prepared for by physicians and patients.