A case of thyroxine (T4) toxicosis complicated by thyroid storm with an unusual precipitant

A case of thyroxine (T4) toxicosis complicated by thyroid storm with an unusual precipitant

Author by Dr. Akolade Idowu

Journal/Publisher: Caspian J Intern Med 2020

Volume/Edition: 11

Language: English

Pages: 231 - 234

Abstract

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.


Other Co-Authors