PATIENT SUMMARY

(A CASE of THYROID STORM)

BY DR ADEYEMO H.A
 HISTORY OF PRESENTING COMPLAINTS
• OE; A 38 YO woman who presented with
yellowing of the eyes *1/12
bilateral leg Swelling *1/12
Generalized body weakness *1/12
Passage of dark colored urine *3/52

• Pt was apparently well until about 1/12 ago when she started complaining of leg
swelling and generalized body weakness.

• Associated Symptoms; Abdominal, Anterior Neck and leg swelling, high grade
fever, passage of loose stools 3-4 x daily, weight loss, palpitations, breathlessness.

• Nil Hx of hematochezia, melena, cold/heat intolerance, orthopnea, LOC, seizures,

blurry vision
 OTHER HISTORY
• Previous Medical Hx;
*Patient was diagnosed of Hyperthyroidism >1
year ago, non-compliant to medication, had
HD(1 session).
 PHYSICAL EXAMINATION
• O/E; She was acutely ill, pale, icteric, warm to touch, mildly
dehydrated with bilateral pitting pedal oedema up to the thigh.
• CVS; PR- 132 (regular, large volume with mixed beats,
collapsing)
HS- S1 and S2

• CHEST; RR- 28cpm, transmitted sound in LLZ

• ABD; Full, MWR, Right upper quadrant tenderness, L0S0K0

• CNS; Conscious but lethargic

 Available Investigations since Admission(FBC)

WBC N L% HCT% PLT RCC HGB

9/1/21 11.7 85.6 10.4 24 333,000
15/1/21 15.72 89.2 5.5 27.4% 169,000 3.52 9.2
14/1/21 23.9(afte
r 2 pints
19/1/21 11.0 93.1 4.3 9.0 138,000 3.29 9.0
18/2/21 6.73 59.7 30.0 28.9 230,000 8..4
 E/U/Cr

Na K HCO3 CL UREA Creatinine

9/1/21 136 3.1 10 104 30 220
12/1/21 133 3.1 15 106 29.6 91.1
14/1/21 136 3.2 16 108 20.7 66.0
15/1/21 131 3.18 15 111 6.8 48
18/1/21 126 5.2 14 101 6.8 34
18/2/21 131 2.9 19 104 1.4 28.5
 LFTS
T. conj. ALP ALT AST GGT ALB TP
billirubi illirubin
n
9/1/21 232.92 168.3 89 254 212 83 24 61
18/1 122.6 77.9 81.3 136 110.3 915 22.6 55.9
13/02 43 34 62 258 20 52
 TFTS
FT3 FT4 TSH
15/1/21 7.20 52.35 0.002
21/1/21 5.87 51.93 0.002
 Urinalysis, Urine m/c/s (11-/1-21)
• Urinalysis- SG-1025, PH-5.0, Protein, Glucose-
neg, Blood-++, Ketones – neg, Bilirubin- neg,
Nitrites-neg, leucocyte esterase ++,
hemoglobin-+
• Urine M/C/S- pus cells >80hpf, RBC- >50/HPF
Epithelial cells; scanty(1-5/hpf)
yeast- numerous>10/hpf
• Fasting Lipid Profile(11-01-21)
TC- 1.61
HDL- 0.18
LDL- 1.08
TG- 1.75
 Other Investigations
• ECG; Atrial Fibrillation with rapid ventricular
response, left ventricular hypertrophy
• ECHOCARDIOGRAM; Good left ventricular and
diastolic function
• CXR; Cardiomegaly
• Abd.pelvic USS; Cholelithiasis
 PT/INR
• PT- 17.1 sec
• PT drug- 17.5
• PT Control-12.0(8-114)
• ISI- 1.03
• INR- 1.44(0.9-1.3)
 Pts Wartofsky point scale
• Temperature- 5
• Tachycardia-20
• Unexplained jaundice- 20
• HF- 10
• Precipitating Event- 10
 Medications
Pt was started on
• Tab carbimazole 20mg tds
• Iv hydrocortisone 2000g 8 hourly
• Oral cholestyramine 4g 8hourly
• Iv omeprazole 20mg 12hourly
• Tab propanolol 200g 8 hourly
• Iv ceftriaxone 1g 12 hourly
• S/C Clexane 40mg daily
• 20ml of 50% D/water 1:1 dilution over 10 mins every 8 hours if
RBS <700mg/dl
• Ivf 10% d/w 500mls 8 hourly + vit C+ vit bco scc
 PT is currently on
• Tab Carbimazole 20mg tds
• Tab hydrocortisone 20;10;10
• Tab Xarelto 10mg daily
• Tab Propanolol 400mg tds
• Cap Astyfer II B.D
• Tab Cholestyramine 4mg tds
• Tab Magnesium oxide 500mg 12hourly
• Tab Nocid II B.D
• Tabs levofloxacin 500mg daily
• Tab flagyl 400mg 8 hourly
• Tab slow-k 600mg b.d
• Cap Omeprazole 20mg b.d
 Summary
• O.E, A 38 YO old female with background
hypertyroidism being managed for resolving
thyroid storm with Atrial Fibrillation
precipitated by background thyrotoxic heart
disease.
THANK YOU!