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Jiman Kim, Eulsun Moon and Seungwon Kwon

Kyunghee-saeng Korean Medicine Clinic. He was previously diagnosed with type 2 diabetes at another hospital and had been receiving oral hypoglycemic agents to control blood glucose levels from 1984 until 2000 when he suffered a stroke. His blood glucose

Open access

Han Soo Park, Su Kyoung Kwon and Ye Na Kim

Summary

Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED). She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT) with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

Learning points:

  • The presenting manifestations of thyroid storm vary and can include cardiac arrest with multiorgan failure in rare cases.
  • In some patients with thyroid storm, especially those with severe complications, conventional medical treatment may be ineffective or inappropriate.
  • During thyroid storm, the initiation of CRRT can immediately lower body temperature and subsequently stabilize vital signs.
  • Early initiation of CRRT can be life-saving in patients with thyroid storm complicated by MOF, even when used in combination with suboptimal medical treatment.
Open access

Laila Ennazk, Ghizlane El Mghari and Nawal El Ansari

was consistent with concomitant pancreatic inflammation. As the concept of autoimmune pancreatitis has changed, the diagnostic criteria has also evolved. The Asian diagnostic criteria ( 6 ) requires two criterions: imaging pancreatic abnormalities

Open access

A Veltroni, G Zambon, S Cingarlini and M V Davì

pathological abnormalities of the pancreatic islets and prior exposure to exogenous insulin ( 1 ). The syndrome is relatively well known in Japan, whereas it is considered rare in the rest of Asia, and it is extremely uncommon in Western countries. After the

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Gautam Das, Vinay S Eligar, Jyothish Govindan and D Aled Rees

androgen levels within a few months after delivery, some atypical features were apparent, including less profound ultrasonic appearances than those reported in the literature and her Asian ethnicity. However, no history of exposure to androgenic drugs was