Thyroid Storm in a Patient With COVID-19

Objective: A thyroid storm is a severe exacerbation of thyrotoxicosis that can cause significant morbidity and mortality. The emergence of the novel coronavirus (SARS-CoV-2) that originated in Wuhan, China, has become a worldwide pandemic. We present the first documented case of thyroid storm (as de...

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Autores principales:	Angela N. Rao, MD, Ruaa Y. Al-Ward, MD, Ruchi Gaba, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	COVID-19 SARS-CoV-2 thyroid thyroid storm Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/6099aec801404180b11faed727024f12
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spelling	oai:doaj.org-article:6099aec801404180b11faed727024f122021-11-06T04:32:55ZThyroid Storm in a Patient With COVID-192376-060510.1016/j.aace.2021.06.011https://doaj.org/article/6099aec801404180b11faed727024f122021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2376060521000845https://doaj.org/toc/2376-0605Objective: A thyroid storm is a severe exacerbation of thyrotoxicosis that can cause significant morbidity and mortality. The emergence of the novel coronavirus (SARS-CoV-2) that originated in Wuhan, China, has become a worldwide pandemic. We present the first documented case of thyroid storm (as defined by the Burch-Wartofsky criteria) in a patient with COVID-19. Methods: Laboratory and diagnostic studies, including thyroid function tests, thyroid antibody testing, SARS-CoV-2 nasopharyngeal polymerase chain reaction testing, and thyroid ultrasound were performed. Results: A 25-year-old woman presented to the hospital with dry cough, dyspnea, palpitations, weight loss, diarrhea, and anxiety. Physical examination revealed exophthalmos with proptosis and chemosis, tachycardia, diffusely enlarged goiter with bruit, and fine tremor. Laboratory results demonstrated a thyroid-stimulating hormone level of <0.01 mIU/L (normal range [NR], 0.44-5.3 mIU/L), free thyroxine level of 5.34 ng/dL (NR, 0.64-1.42 ng/dL), total triiodothyronine level of 654 ng/dL (NR, 87-178 ng/dL), and thyroid-stimulating immunoglobulin level of 7.18 IU/L (NR, 0.00-0.55 IU/L). Thyroid ultrasound revealed heterogeneous echotexture with increased vascularity. Nasopharyngeal COVID-19 testing was positive. She was treated promptly with propranolol, propylthiouracil, and hydrocortisone with improvement in symptoms, and later switched to methimazole. Her COVID-19 course was uncomplicated, and she left the hospital with minimal respiratory symptoms. Conclusion: Thyroid storms are one of the more prevalent endocrine emergencies and are often precipitated by acute events including infections. Patients with thyroid storms may have concomitant SARS-CoV-2 infection that could influence the clinical course and severity of the disease. In patients with symptoms of thyrotoxicosis and respiratory symptoms, clinicians should consider performing a COVID-19 test.Angela N. Rao, MDRuaa Y. Al-Ward, MDRuchi Gaba, MDElsevierarticleCOVID-19SARS-CoV-2thyroidthyroid stormDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENAACE Clinical Case Reports, Vol 7, Iss 6, Pp 360-362 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 SARS-CoV-2 thyroid thyroid storm Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	COVID-19 SARS-CoV-2 thyroid thyroid storm Diseases of the endocrine glands. Clinical endocrinology RC648-665 Angela N. Rao, MD Ruaa Y. Al-Ward, MD Ruchi Gaba, MD Thyroid Storm in a Patient With COVID-19
description	Objective: A thyroid storm is a severe exacerbation of thyrotoxicosis that can cause significant morbidity and mortality. The emergence of the novel coronavirus (SARS-CoV-2) that originated in Wuhan, China, has become a worldwide pandemic. We present the first documented case of thyroid storm (as defined by the Burch-Wartofsky criteria) in a patient with COVID-19. Methods: Laboratory and diagnostic studies, including thyroid function tests, thyroid antibody testing, SARS-CoV-2 nasopharyngeal polymerase chain reaction testing, and thyroid ultrasound were performed. Results: A 25-year-old woman presented to the hospital with dry cough, dyspnea, palpitations, weight loss, diarrhea, and anxiety. Physical examination revealed exophthalmos with proptosis and chemosis, tachycardia, diffusely enlarged goiter with bruit, and fine tremor. Laboratory results demonstrated a thyroid-stimulating hormone level of <0.01 mIU/L (normal range [NR], 0.44-5.3 mIU/L), free thyroxine level of 5.34 ng/dL (NR, 0.64-1.42 ng/dL), total triiodothyronine level of 654 ng/dL (NR, 87-178 ng/dL), and thyroid-stimulating immunoglobulin level of 7.18 IU/L (NR, 0.00-0.55 IU/L). Thyroid ultrasound revealed heterogeneous echotexture with increased vascularity. Nasopharyngeal COVID-19 testing was positive. She was treated promptly with propranolol, propylthiouracil, and hydrocortisone with improvement in symptoms, and later switched to methimazole. Her COVID-19 course was uncomplicated, and she left the hospital with minimal respiratory symptoms. Conclusion: Thyroid storms are one of the more prevalent endocrine emergencies and are often precipitated by acute events including infections. Patients with thyroid storms may have concomitant SARS-CoV-2 infection that could influence the clinical course and severity of the disease. In patients with symptoms of thyrotoxicosis and respiratory symptoms, clinicians should consider performing a COVID-19 test.
format	article
author	Angela N. Rao, MD Ruaa Y. Al-Ward, MD Ruchi Gaba, MD
author_facet	Angela N. Rao, MD Ruaa Y. Al-Ward, MD Ruchi Gaba, MD
author_sort	Angela N. Rao, MD
title	Thyroid Storm in a Patient With COVID-19
title_short	Thyroid Storm in a Patient With COVID-19
title_full	Thyroid Storm in a Patient With COVID-19
title_fullStr	Thyroid Storm in a Patient With COVID-19
title_full_unstemmed	Thyroid Storm in a Patient With COVID-19
title_sort	thyroid storm in a patient with covid-19
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6099aec801404180b11faed727024f12
work_keys_str_mv	AT angelanraomd thyroidstorminapatientwithcovid19 AT ruaayalwardmd thyroidstorminapatientwithcovid19 AT ruchigabamd thyroidstorminapatientwithcovid19
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Thyroid Storm in a Patient With COVID-19

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