Ridda Khattak, Enrique Cortez, Madihah Alam, Rohab Sohail, Zaraq Khan, Maria Azhar
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Thyroid Storm in the Shadows of Multiple Endocrine Neoplasia (Men) 2A: A Case of Overlapping Endocrine Emergencies.
Thyroid storm is observed in patients with untreated Graves' disease, typically triggered by stressors such as acute illness or recent surgery. This case presents a female with acute metabolic encephalopathy initially attributed to drug overdose and septic shock, later diagnosed with thyroid storm. Despite clinical stabilisation, the patient developed resistant hypertension and elevated metanephrine levels, raising suspicion for phaeochromocytoma and potential multiple endocrine neoplasia (MEN) 2A. This case highlights the importance of considering syndromic and autoimmune associations in complex endocrine presentations.
Learning points: Thyroid storm should be considered when there is a rising temperature and increasing agitation despite appropriate treatment.If hypertension persists after the fever of thyroid storm was managed with propylthiouracil and iodine an additional diagnosis, such as phaeochromocytoma, should be considered.We found no published reports on MEDLINE linking Graves' disease or thyroid storm with MEN 2A to help guide our management.
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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