Iatrogenic cardiac arrest during thyroid storm

Abstract

Introduction: Thyroid storm is a life-threatening condition with often severe cardiac implications. Correct treatment choices can vary depending on underlying cardiac systolic function. Case description: We present a case of a 47-year-old male with untreated Grave’s disease who presented with a thyroid storm. After propranolol administration, he experienced a cardiac arrest with the return of spontaneous circulation after cardiopulmonary resuscitation. Further evaluation revealed severe thyroid-induced cardiomyopathy with left ventricular ejection fraction of 15–20%, which had decreased from 60–65% over one year. The patient was discharged home on hospital day 8 after an unremarkable ischaemic work-up. He experienced a full cardiac systolic function recovery with an ejection fraction of 60–65% at the 90-day follow-up. Conclusion: Thyroid storm can present with overt or subclinical heart failure. Prompt evaluation of cardiac systolic function with a transthoracic echocardiogram before beta-blockade and the use of shorter-acting beta blockers can prevent devastating suppression of myocardial function.

Keywords

• thyroid storm
• cardiac arrest
• beta blockers
• cardiomyopathy