Malignant Arrhythmias as the Unmasked Manifestation of Thyroid Storm

Figures & data

Table 1 Summary of the Laboratory Data

	Reference Value	At Arrival	D1	D2	D3	D4
WBC(x 109/L)	3.5–9.5	8.71	2.1	3.17	3.76	5.59
ALT (U/L)	5–40	21	17	28	32	30
AST (U/L)	8–40	64	62	40	45	31
TBIL (umol/L)	3.4–23.3	157.5	119.2	118	139.7	140
DBIL (umol/L)	≤6.8		75.2
ALP(U/L)	40–130	114	73	73	81	83
TBA(umol/l)	≤10	63.6
GGT(U/L)	7–45	50	29	42	61	63
ALB (g/l)	35–55	28.3	26.4	29.1	33.4	30.7
CKMB(U/L)	≤24	71		44	46	42
CK(U/L)	30–170	273		48	34	30
UREA (mmol/l)	2.5–7.5	4.47		5.68	5.52	5.28
Cr (umol/l)	53–130	25		13	19	15
UA (umol/l)	149–369	198		203	236	209
K+ (mmol/L)	3.5–5.5	3.59		3.9	3.53	3.58
Na+ (mmol/L)	135–145	126.6		144.2	144.2	139.5
GLU(mmol/L)	3.6–6.1	6.2	5.3	7.5	6	6.7
Ca (mmol/l)	2–2.7	1.98	1.89	1.97	2.01	2.04

Figure 1 Electrocardiogram at admission. Atrial fibrillation, mild ST segment depression in leads V 3–6.T wave inversion.

Figure 2 Diagnosis and treatment of the patient.

Figure 3 Electrocardiogram after resuscitation. Still atrial fibrillation, ST segment depression was significantly deepened and ST segment elevation in aVR lead.

Table 2 Clinical Characteristics of Thyroid Storm and Malignant Arrhythmia

Age/Sex	Causes of Thyrotoxicosis	Symptoms	Inducer of Thyroid Storm	BWPS Score	Type of Arrhythmia	Time from Admission to Malignant Arrhythmia	Treatment	Prognosis
35/F^Citation1	Graves’	Fever, palpitations	Drug withdrawal	50	Ventricular tachycardia	34 h	Propylthiouracil Hydrocortisone iodine	Discharged
69/M^Citation2	Graves’	Vomiting diarrhoea	Infection drug withdrawal	55	Ventricular fibrillation	4 days	Iodine Hydrocortisone beta-blockers	Death
52/F^Citation3	Graves’	Dyspnoea	Irregular treatment	35–55	Ventricular tachycardia	Several hours	Propranolol Propylthiouracil corticosteroids	Discharged
18/F^Citation4	Not known	Fever, dyspnoea	Infection	55	Ventricular fibrillation	Not known	Prothiouracil Iodine Hydrocortisone propranolol	Discharged
34/F^Citation5	Graves’	Dyspnoea	Drug withdrawal	–	Ventricular fibrillation	Five minutes	Propylthiouracil Hydrocortisone iodine solution propranolol	Death
23/M^Citation6	Not known	Fever, cough	Infection	–	Ventricular fibrillation	Not known	Methimazole Iodine Hydrocortisone metoprolol tartrate	Discharged
12/F^Citation7	Goitre	Postoperative	Surgery	–	Ventricular fibrillation	Several minutes	Methimazole Iodine hydrocortisone
46/F^Citation8	Graves’	Cough dyspnoea oedema	–	-	Torsades de pointes Ventricular tachycardia	Soon	Carbimazole atenolol	Discharged
18/M^Citation9	Graves’	Disturbance of consciousness	Drug withdrawal	45	Ventricular fibrillation	Not known	Propylthiouracil Hydrocortisone iodine	Discharged
51/F	Graves’	diarrhoea, fever	Infection and drug withdrawal	80	Ventricular fibrillation	Five days	Propylthiouracil Hydrocortisone beta blockers	Death

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