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Medical Science Monitor Basic Research


Thyroid Storm Complicated by Bicytopenia and Disseminated Intravascular Coagulation

Unusual clinical course

Yoshinori Tokushima, Yuta Sakanishi, Kou Nagae, Midori Tokushima, Masaki Tago, Motosuke Tomonaga, Tsuneaki Yoshioka, Masaki Hyakutake, Takashi Sugioka, Shu-ichi Yamashita

Japan Department of General Medicine, Saga University Hospital, Saga city, Japan

Am J Case Rep 2014; 15:312-316

DOI: 10.12659/AJCR.890519

Available online: 2014-07-24

Published: 2014-07-24


Background: The clinical presentation of thyroid storm includes fever, tachycardia, hypertension, and neurological abnormalities. It is a serious condition with a high mortality rate. Furthermore, some other complications affect the clinical course of thyroid storm. Although it is reported that prognosis is poor when thyroid storm is complicated by disseminated intravascular coagulation syndrome (DIC) and leukopenia, reports of such cases are rare.
Case Report: A 23-year-old man presented with delirium, high pyrexia, diarrhea, and weight loss of 18 kg over 2 months. According to the criteria of Burch and Wartofsky, he was diagnosed with thyroid storm on the basis of his symptom-complex and laboratory data that confirmed the presence of hyperthyroidism. Investigations also found leukopenia, thrombocytopenia, and disseminated intravascular coagulation, all of which are very rare complications of thyroid storm. We successfully treated him with combined therapy including anti-thyroid medication, despite leukopenia.
Conclusions: Early diagnosis and treatment are essential in ensuring a good outcome for patients with this rare combination of medical problems.

Keywords: Antithyroid Agents - therapeutic use, Adrenergic beta-Antagonists - therapeutic use, Disseminated Intravascular Coagulation - etiology, Drug Therapy, Combination, Iodates - therapeutic use, Leukocyte Count, Leukopenia - etiology, Methimazole - therapeutic use, Potassium Compounds - therapeutic use, Propranolol - therapeutic use, Thyroid Crisis - drug therapy, young adult