Ann Clin Case Rep | Volume 7, Issue 1 | Case Report | Open Access

High Scored Thyroid Storm after Stomach Cancer Perforation: A Case Report and Review of the Literature

Seung Min Baik1,2, Yejune Pae3 and Jae-Myeong Lee4*

1Department of Critical Care Medicine & Surgery, Ewha Womans University Mokdong Hospital, Republic of Korea 2Department of Surgery, College of Medicine, Graduate School of Korea University, Republic of Korea 3Korea University College of Medicine, Republic of Korea 4Department of Surgery, Division of Acute Care Surgery, Korea University Anam Hospital; University College of Medicine, Republic of Korea

*Correspondance to: Jae-Myeong Lee 

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Abstract

Thyroid storm is a life-threatening emergency. Reportedly, the prevalence of thyroid storm is 1% to 2% among patients admitted to the hospital for thyrotoxicosis. Burch and Wartofsky (1993) introduced a scoring system using precise clinical criteria to identify thyroid storms. Only 17 cases of thyroid storm with a score >70 points have been reported. Although thyroid storms are uncommon, their clinical findings resemble those of sepsis. A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation; medications for hypertension, diabetes mellitus, and hyperthyroidism had been suspended 1 year prior to this visit. We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation, and the patient was referred to the surgical Intensive Care Unit (ICU). On the 2nd day in the ICU, his Body Temperature (BT) increased to 41.3°C at 19:00, with the thyroid storm score peaking at 18:00 (BT; 41.2ºC, Pulse Rate [PR]; 138/min, irritable status). The patient was administered propylthiouracil, intravenous glucocorticoids, acetaminophen, and Lugol’s solution daily. Subsequently, we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT. His vital signs were stable on the 8th day in the ICU. Thyroid storms are uncommon, with few reports in the literature; however, their clinical findings resemble those of sepsis and require further investigation. Since an untreated thyroid storm results in a high mortality rate, it should be investigated when managing sepsis.

Keywords:

Thyroid storm; Stomach cancer; Severity score

Citation:

Baik SM, Pae Y, Lee J-M. High Scored Thyroid Storm after Stomach Cancer Perforation: A Case Report and Review of the Literature. Ann Clin Case Rep. 2022; 7: 2201..

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