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Background: Thyroid crisis is a life-threatening condition in thyrotoxic patients. Although differentiated thyroid cancer is one of the causes of hyperthyroidism, reports on thyroid crisis caused by thyroid cancer are quite limited. Here, we describe a case of thyroid crisis caused by metastatic thyroid cancer., Case Presentation: A 91-year-old woman was admitted to our hospital because of loss of appetite. Two years prior to this hospitalization, she presented with subclinical thyrotoxicosis and was diagnosed with histologically unidentified thyroid cancer with multiple metastases, and she refused aggressive medical interventions. On admission, she exhibited extreme thyrotoxicosis, and the presence of fever, severe tachycardia, impaired consciousness, and heart failure revealed the presence of thyroid crisis. All thyroid autoantibodies were negative. Multidisciplinary conservative treatment was initiated; however, she died on the fifth day after admission. Autopsy revealed the presence of primary anaplastic thyroid carcinoma and multiple metastatic foci arising from follicular thyroid carcinoma. Both primary and metastatic follicular thyroid carcinoma likely induced thyrotoxicosis, which could have been exacerbated by anaplastic thyroid carcinoma., Conclusions: Even though the trigger of thyroid crisis in this patient is not clear, the aggravated progression of her clinical course suggests that careful monitoring of thyroid hormones and appropriate intervention are essential for patients with thyroid cancer., (© 2021. The Author(s).)

Rationale: Various neurological manifestations are observed in thyroid storm patients but protracted disturbance of consciousness is rare., Patient Concerns: A 58-year-old male was admitted to our hospital after a traffic accident., Diagnoses: Although awake on arrival, he fell into coma after admission. Based on the clinical symptoms and hyperthyroidism, the patient was diagnosed with thyroid storm (TS)., Interventions: Even after improvement of hyperthyroidism, disturbance of consciousness was protracted. Considering the possibility of immune-related etiology, methylprednisolone pulse was started., Outcomes: His consciousness level improved over a 3-month period, and he became able to walk with some assistance after 6 months., Lessons: His condition was atypical of TS-associated encephalopathy because of the long clinical course. Reversible splenial lesion was visible using brain imaging. In some cases of TS, disturbance of consciousness can be protracted for several months, but it is reversible. Therefore, it is necessary to judge the long-term neurological outcome carefully.

Rationale: Heart failure is relatively common in patients with hyperthyroidism, but thyrotoxic cardiomyopathy with poor left ventricular (LV) systolic function is very rare., Patient Concerns: We experienced a representative case of a patient who presented with severe LV dysfunction related to thyroid storm and needed extracorporeal membrane oxygenation (ECMO) temporally., Diagnosis: Thyrotoxic cardiomyopathy., Interventions and Outcomes: Aggressive antithyroid therapy, including steroid pulse to hyperthyroidism, leads to the dramatic improvement of cardiac function and she was successfully weaned from ECMO., Lessons: The most outstanding feature of the current case was the rapid decrease of cardiac injury and improvement of cardiac function by strengthening antithyroid therapy, including steroid pulse, without thyroid hormone level normalization. In thyroid storm, various systemic inflammatory reactions have different time courses and among them, the cardiac phenotype emerges in most striking and critical ways.

A 2-year-old girl with cardiorespiratory distress and suspected pulmonary embolism (PE) was referred for urgent lung perfusion scintigraphy, proven negative for perfusion defects but unexpectedly revealing an enlarged orthotopic thyroid. This finding was, under the circumstances, considered as suggestive of thyroid storm (TS), subsequently confirmed by thyroid hormones measurement. A (99m)TcO(4)(-) thyroid scan 1 week later showed a homogenously enlarged thyroid with high tracer uptake. Both PE and TS are rare but serious pediatric conditions with partially overlapping presentations. In the present case, the unbounded (99m)Tc fraction avidly taken by the overfunctioning thyroid suggested the correct, clinically unsuspected, diagnosis.

A 52-year-old woman, who had an out-of-hospital cardiac arrest, was resuscitated, intubated and transferred with cardiogenic shock to angioplasty of the right coronary artery. Afterwards the patient had normal biventricular function, but four days later she developed atrial fibrillation and recurrent cardiogenic shock with a left ventricular ejection fraction of 20%. Thyrotoxic crisis was determined as the underlying cause; and antithyroid treatment stabilised the patient's haemodynamics completely within 24 hours. The importance of high thyroxine levels in patients with ischaemic heart disease is discussed.

Thyroid storm is a rare and life-threatening complication of untreated thyrotoxicosis. A number of neurological complications have been described in association with thyrotoxicosis. We report the case of a 28-year-old woman with a thyroid storm on the basis of Graves' disease and probably triggered by a surgical procedure. She developed cerebral venous thrombosis (CVT) of the left transverse and rectus sinus with a venous infarction of the left thalamus. Except for an increased factor VIII clotting activity there were no thrombophilic abnormalities. Similar cases have been described in the literature and the reported incidence of the combination of CVT and thyrotoxicosis is significantly higher than expected by chance alone (0.1 x 10(-6) per year vs. 0.0032 x 10(-6)/year). This case is consistent with the assumption that thyrotoxicosis, probably through a factor VIII-mediated hypercoagulability, may be a predisposing factor for the development of CVT.

We describe a 30 year old woman who presented with thyroid storm. She had non-specific symptoms and few clinical signs of hyperthyroidism despite markedly raised thyroid hormone concentrations. Soon after admission her behaviour became abnormal and her level of consciousness deteriorated. Despite the rapid restoration of thyroid hormone concentrations to normal using conventional therapies, and correction of hypoxia resulting from acute pulmonary oedema, her level of consciousness did not improve. Cranial CT scanning revealed extensive bilateral basal ganglia infarction, a previously unreported complication of thyroid storm. This observation suggests that thyroid storm may predispose to hypoxic neurological damage.