Thyroid Storm With Paroxysmal Atrial Flutter In Patients With Untreated Hyperthyroidism: Emergency Treatment And Effectiveness Of Disease Control

Abstract

The thyroid gland is a relatively small gland located in the front of the neck and has the function of producing thyroid hormones. Thyroid hormone helps the body use energy and control some activities. They have an impact on the body's calorie-burning rate, breathing rate, digestive activity and even heart rate. Sometimes the thyroid gland secretes too much hormone and causes hyperthyroidism, which causes many body functions to become hyperactive [1], [2], [3] , [4]. If left untreated, this condition can lead to a more dangerous condition called thyroid storm. Thyroid storm is a rare complication of thyrotoxicosis. There are 4 main clinical features of thyroid storm: mental disorders, high fever, rapid pulse, and gastrointestinal disorders [1], [2, [3], [4], [5]  If left untreated it can lead to atrial fibrillation, acute heart failure and fluid accumulation in the lungs, pulmonary edema, vascular collapse, coma, and death within 72 hours. Despite early diagnosis, the mortality rate remains high at 10-30% [3], [4], [6], [7], [8].

The underlying cause of a thyroid storm is hyperthyroidism. Thyroid storm is often precipitated by several factors such as infection, viral infection, Grave's disease, some other autoimmune diseases, use of iodine-containing contrast agents, internal medicine, pregnancy, surgery, trauma all stress cases (hyper-catecholamine), or some acute diseases [1], [2], [9], [10]. In this report, we describe a case of a patient with thyroid storm who had paroxysmal atrial fibrillation, heart failure, and large pleural effusion on the background of hyperthyroidism but had not received any previous treatment for hyperthyroidism, intending to share more complex clinical scenarios as well as management, monitoring, and treatment for each different clinical entity.