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Journal article
Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis
Journal of community hospital internal medicine perspectives, v 6(4), 31750
2016
PMID: 27609719
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza.
A 69-year-old diabetic female was found by the paramedic staff to be disoriented. She demonstrated tachycardia and had a foul-smelling abdominal wound. Laboratory evaluation revealed DKA, leukocytosis, influenza B, and urinary tract infection. After appropriate management in the intensive care unit, the DKA resolved the following morning. However, the patient developed a fever, and her psychosis became more pronounced. Extensive analysis was performed but did not explain her mental status. The patient was found to have thyroid stimulating hormone of 0.06 mIU/mL, free T4 (thyroxine) of 2.38 ng/dL, and total T3 (triiodothyronine) of 72 ng/dL. Based on the Burch and Wartofsky criteria (score of 65), TS was diagnosed. Based on more recent diagnostic criteria suggested by Akamizu et al., the patient met criteria for TS grade 1. Within several hours of initiating treatment, the patient's mental state and tachycardia improved, and her psychosis resolved by the third day.
This case highlights the importance of recognizing the clinical diagnosis of TS, as the magnitude of thyroid hormone derangements may not correlate with clinical severity. While rare, DKA and TS can simultaneously occur and are associated with increased morbidity and mortality if not promptly recognized and treated.
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Details
- Title
- Thyroid storm presenting as psychosis: masked by diabetic ketoacidosis
- Creators
- Raafia Memon - Department of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USA;WuQiang Fan - Department of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USA;Richard Snyder - Department of Internal Medicine, Easton Hospital, Academic Affiliate of Drexel University College of Medicine, Easton, PA, USA;Mahesh Krishnamurthy - Drexel University
- Publication Details
- Journal of community hospital internal medicine perspectives, v 6(4), 31750
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate)
- Web of Science ID
- WOS:000393411600019
- Other Identifier
- 991019169332904721
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- Web of Science research areas
- Endocrinology & Metabolism