Multisystem Clues Pointing to Thyroid Storm: A Case of New-Onset Hyperthyroidism with Delayed Recognition and Severe Systemic Complications

Abstract

Introduction: Thyrotoxic crisis is a rare, but potentially fatal endocrine emergency resulting from a sudden surge in thyroid hormone activity. Early recognition is critical, however atypical or multisystem presentations can delay diagnosis and treatment.

Case Presentation: We present the case of a 39 year old female who was referred to the Emergency Department with the symptoms of diarrhea, palpitations, and restlessness. On examination, she exhibited tachycardia, jaundice, mild pyrexia, and signs of heart failure with anasarca. Laboratory workup revealed severe anemia, pancytopenia, metabolic acidosis, and hyperbilirubinemia. Imaging findings were consistent with goiter, cardiomegaly, hepatomegaly, and ascites. Thyroid function tests showed markedly suppressed TSH and elevated free T3 and free T4 levels, with positive thyroid antibodies. Alongside with a score of 90 on the Burch-Wartofsky scale, the diagnosis of thyroid storm was confirmed. She was admitted to the Intensive Care Unit twice during hospitalization, first for thyrotoxic crisis, and later for sepsis with multiorgan dysfunction. Targeted endocrine, antimicrobial, and supportive therapy led to clinical improvement.

Conclusion: This case underscores the importance of considering thyroid storm in patients with unexplained multisystem involvement. A high index of suspicion, even in the absence of prior thyroid disease, is essential for timely diagnosis and improved outcomes.