Case report: a patient with thyroid storm, refractory cardiogenic shock, and cardiac arrest treated with Lugol's iodine solution and veno-arterial extra corporal membrane oxygenation support.
Cardiac arrest
Cardiogenic shock
Case report
Levosimendan
Thyrotoxicosis
Veno-arterial extracorporeal membrane oxygenation
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
02
07
2020
revised:
01
09
2020
accepted:
15
12
2020
entrez:
11
2
2021
pubmed:
12
2
2021
medline:
12
2
2021
Statut:
epublish
Résumé
Thyroid storm is a life-threatening condition. Refractory cardiogenic shock and cardiac arrest are rare complications of thyroid storm and the treatment options are limited. A 35-year- old woman treated for Grave's disease was admitted with thyrotoxicosis complicated by infection and neutropenia caused by thionamide treatment. After treatment including beta-blockers, steroids, and Lugol's iodine solution, she went into cardiac arrest. Echocardiography after resuscitation demonstrated severe biventricular heart failure. The patient was in refractory cardiogenic shock with recurrent cardiac arrest and mechanical circulatory support with a veno-arterial extra corporal membrane oxygenation (V-A ECMO) circuit was established. After 2 days on V-A ECMO and supportive treatment with iodine solution, glucocorticosteroids, and levosimendan, her myocardial function recovered and thyroid hormone levels were normalized. Veno-arterial extra corporal membrane oxygenation was discontinued, and the patient was treated with early total thyroidectomy. The patient made a full recovery with no neurological/cognitive impairment, as assessed after 4 weeks. Adverse reactions to standard treatment of hyperthyroidism contributed to this patient's development of thyroid storm and the following refractory cardiogenic shock. When she was critically unstable, levosimendan improved myocardial function while inotropic support with dobutamine was ineffective, likely due to prolonged beta-antagonist administration. Temporary support with V-A ECMO, until effective lowering of thyroid hormone levels and improvement in myocardial function were obtained, was life-saving in this young patient and may be considered in refractory cardiogenic shock caused by thyroid storm.
Sections du résumé
BACKGROUND
BACKGROUND
Thyroid storm is a life-threatening condition. Refractory cardiogenic shock and cardiac arrest are rare complications of thyroid storm and the treatment options are limited.
CASE SUMMARY
METHODS
A 35-year- old woman treated for Grave's disease was admitted with thyrotoxicosis complicated by infection and neutropenia caused by thionamide treatment. After treatment including beta-blockers, steroids, and Lugol's iodine solution, she went into cardiac arrest. Echocardiography after resuscitation demonstrated severe biventricular heart failure. The patient was in refractory cardiogenic shock with recurrent cardiac arrest and mechanical circulatory support with a veno-arterial extra corporal membrane oxygenation (V-A ECMO) circuit was established. After 2 days on V-A ECMO and supportive treatment with iodine solution, glucocorticosteroids, and levosimendan, her myocardial function recovered and thyroid hormone levels were normalized. Veno-arterial extra corporal membrane oxygenation was discontinued, and the patient was treated with early total thyroidectomy. The patient made a full recovery with no neurological/cognitive impairment, as assessed after 4 weeks.
DISCUSSION
CONCLUSIONS
Adverse reactions to standard treatment of hyperthyroidism contributed to this patient's development of thyroid storm and the following refractory cardiogenic shock. When she was critically unstable, levosimendan improved myocardial function while inotropic support with dobutamine was ineffective, likely due to prolonged beta-antagonist administration. Temporary support with V-A ECMO, until effective lowering of thyroid hormone levels and improvement in myocardial function were obtained, was life-saving in this young patient and may be considered in refractory cardiogenic shock caused by thyroid storm.
Identifiants
pubmed: 33569532
doi: 10.1093/ehjcr/ytab017
pii: ytab017
pmc: PMC7859599
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytab017Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Endocrine. 2017 Dec;58(3):467-473
pubmed: 29075974
Eur Heart J Suppl. 2020 May;22(Suppl D):D3-D11
pubmed: 32431568
J Clin Endocrinol Metab. 2015 Feb;100(2):376-83
pubmed: 25375985
J Clin Endocrinol Metab. 2002 Mar;87(3):968-74
pubmed: 11889145
Eur J Pharmacol. 1978 Aug 15;50(4):337-47
pubmed: 212274
Int J Endocrinol. 2018 Apr 22;2018:5794054
pubmed: 29849619
Circulation. 2007 Oct 9;116(15):1725-35
pubmed: 17923583
Eur J Pharmacol. 2011 Sep 30;667(1-3):32-40
pubmed: 21693117
Drugs R D. 2017 Mar;17(1):91-96
pubmed: 28105610
Curr Hypertens Rep. 2003 Dec;5(6):513-20
pubmed: 14594573
Cureus. 2019 Jul 4;11(7):e5079
pubmed: 31511808
Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86, vii
pubmed: 17127140
N Engl J Med. 2019 Aug 22;381(8):749-761
pubmed: 31433922