Impending Thyroid Storm – An Alarming Manifestation in Unidentified Hyperthyroidism–A Case Report


  • Madhavi gaddam


A 46-year-old male patient, who underwent decortication with right poster lateral thoracotomy developed atrial fibrillation in the postoperative period, which was identified with continuous ECG monitoring. He was managed with parenteral beta blockers, hydrocortisone, oxygenation and IV fluids. The patient was investigated thoroughly for the cause of atrial fibrillation in addition to the preoperative evaluation. As the patient had no obvious risk factors such as cardiac failure, hypertension, ischemic heart disease, rheumatic heart disease or alcoholic intoxication he was ultimately assessed for the thyroid function. The thyroid profile showed extremely low levels of thyrotropin (TSH) with elevated T3, T4 levels. Patient was treated with carbimazole and Propranolol to which he responded.


Akamizu T, Satoh T, Isozaki O, Suzuki A et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Japan Thyroid Association. Thyroid 2012;22(7):661.

Leslie J, DeGroot MD et al. Diagnosis and Treatment of Graves’ Disease– Thyroid disease anager-pdf; Last Updated: February 13, 2012,

Burman K, Nayak B. Thyrotoxicosis and thyroid storm. Endocrinol & Metab Clin North Am 2007;35(4):663– 86, vii.

Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77. [PubMed]

Jiang YZ, Hutchinson KA, Bartelloni P, Manthous CA. Thyroid storm presenting as multiple organ dysfunction syndrome. Chest 2000;118:877– 9. [PubMed]

Yoshino T, Kawano D, Azuhata T, Kuwana T, Kogawa R, Sakurai A, Tanjoh K, Yanagawa T. A patient with graves disease who survived with dispite thyroid storm and lactic acidosis. Ups J Med Sci 2010;115(4):282–286. Published online 2010 October 27.

Sharma, R, Shastri BVR, Motiani P. An unusual presentation of intraoperative thyroid storm–A case report. Indian J Anaesth 2003; 47(2):137.

Yamasaki H, Yabe M, Terai T. Case of paroxysmal atrial fibrillation after general anesthesia caused by undiagnosed and untreated hyperthyroidism.- Masui 2009;58(10):1290–2.

Nakamura S, Nishmyama T, Hanaoka K. Perioperative thyroid storm in a patient with undiscovered hyperthyroidism. Masui, Japanese J Anaesth 2005; 54(4):418–9.

Grimes CM, Muniz H, Montgomery WH, Goh YS. Intraoperative thyroid storm: A case report. AANA J 2004;72(1).






Case Report