Thyroid storm is a rare but life-threatening condition in thyrotoxic patients. The keys to successful management of thyroid storm are early diagnosis, immediate anti-thyroid medications, and preventing multiorgan failure. We present a case of thyroid storm, acute decompensated heart failure, and atrial fibrillation with rapid ventricular response. We initiated propranolol to control thyroid storm. Soon after, the patient developed more severe heart failure with decreased ejection fraction (EF). We switched to diltiazem to control tachycardia, but the therapeutic effect was unsatisfactory. Finally, we used an ultra-short-acting beta-adrenergic blockade with strict monitoring of heart rate and echocardiography, and the patient survived. Beta-adrenergic blockades should be used cautiously in thyroid storm, especially patients with severe heart failure. Echocardiography can be used to aid in selection and monitoring of therapeutic drugs and prognostic outcomes in patients with thyroid storm and heart failure.
Keyphrases
- heart failure
- ejection fraction
- left ventricular
- atrial fibrillation
- heart rate
- cardiac resynchronization therapy
- pulmonary hypertension
- blood pressure
- acute heart failure
- computed tomography
- case report
- aortic stenosis
- end stage renal disease
- catheter ablation
- chronic kidney disease
- metabolic syndrome
- newly diagnosed
- extracorporeal membrane oxygenation
- skeletal muscle
- drug induced
- mitral valve
- aortic valve
- high resolution
- mechanical ventilation