Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm

Wen Shang, Qing-Bian Ma Department of Emergency, Perking University Third Hospital, Beijing 100191, People’s Republic of ChinaCorrespondence: Qing-Bian MaDepartment of Emergency, Perking University Third Hospital, 49 Huayuan North Road, Beijing 100191, People’s Republic of ChinaTel +86-10-82264047Fax +86-10-82264040Email maqingbian@medmail.com.cnAbstract: Thyroid storm is usually due to a severe exacerbation of a preexisting thyrotoxicosis, which later leads to decompensation in different organ systems. Thyroid storm with malignant arrhythmia is rare, but the mortality rate is high. Malignant arrhythmia has usually occurred in some patients with hypokalemia or ischemic heart disease. The presentation of these arrhythmias in the initial phase of the disease is much less common, and only a few isolated cases are described in the scientific literature. This paper analyzes and summarizes the clinical characteristics of this disease through literature reviews, for clinicians early detection and diagnosis of this disease. We report a 51-year-old woman with diarrhoea, fever, thyroid storm, ventricular fibrillation and no potential heart disease. The case report is discussed using relevant data from literature. A total of 9 patients were reported in the literature, totalling 10 cases with ours, including 7 cases of ventricular fibrillation and 3 cases of ventricular tachycardia. Most of the treatments were antithyroid drugs, hormones and beta-receptor blockers, and 3 death cases. Patients with thyroid crisis need to be closely monitored for malignant arrhythmias. Early diagnosis and treatment may save lives.Keywords: thyroid storm, malignant arrhythmia, ventricular tachycardia