CASE STUDY

CASE #4: Nightly fevers and weight loss

Submitted by Aubrey Corrigan, PA-S

Diagnosis: Thyroid storm

Follow-up: The emergency medical service was called and the patient was transported to the hospital emergency room. At presentation, this patient exhibited signs that led the medical staff to believe that he could be in thyroid storm. Even though his symptoms could have been due to dehydration or an anemia, the possibility of thyroid storm must be addressed and ruled out as a source of the symptoms.

Thyroid medications can cause a patient to go into crisis due to their small therapeutic range; if the level is too high it can push patients from euthyroid to hyperthyroid, or even into crisis. The patient was on 100 micrograms of levothyroxine daily. National guidelines recommend that patients are dosed at 1.6 micrograms/kilograms/day. Because this patient is 56.75 kg, his recommended dose would be 90.8 micrograms/day; he is taking 100 micrograms/day. The higher dosage may have caused his thyroid to become overactive, bringing him to crisis.

The patient was sent to the emergency room for proper evaluation to rule out thyroid storm as well as other diagnoses. Thyroid storm is life threatening and must be recognized early and treated to prevent patient death. A good rule to follow in any area of medicine is when a diagnosis is considered, it must be either ruled in, or ruled out. It is the job of the clinician not only to find the right diagnosis, but also to prove that the other possibilities are wrong.

Click here to read Thyroid storm: Natural disaster or man made?