Thyroid Storm With Myocardial Injury Mimicking Acute Coronary Syndrome: A Case Report and Literature Review

TL;DR

A case report shows thyroid storm can mimic heart attack symptoms, emphasizing the need for quick diagnosis to avoid severe heart issues.

Contribution

Highlights the clinical challenge of distinguishing thyroid storm from acute coronary syndrome through a detailed case analysis.

Findings

Thyroid storm can present with ECG changes and elevated troponin, mimicking acute coronary syndrome.

The patient's condition improved with beta-blockers, anti-thyroid drugs, and iodine therapy.

Radioactive iodine ablation was used after stabilization to treat Graves’ disease.

Abstract

Thyroid storm presents a fatal medical emergency that develops when thyrotoxicosis advances to its most critical stage. A 50-year-old male patient with no known thyroid problems presented to the hospital complaining of several episodes of diarrhea, tachycardia, and chest pain with ECG changes suggestive of ischemia. Laboratory tests confirmed thyrotoxicosis with a low level of thyroid-stimulating hormone, while free T4 and T3 levels were significantly elevated. Further workup revealed Graves’ disease (positive anti-thyroid peroxidase antibody results and elevated radioactive iodine uptake). The patient received intensive treatment in the ICU, including beta-blockade therapy, anti-thyroid medications, iodine solution, corticosteroids, and supportive medical care. Despite initial concerns for acute coronary syndrome due to troponin elevation and ST depressions, coronary angiography showed no obstructive disease. This indicates a type II myocardial infarction from supply-demand mismatch. The patient underwent radioactive iodine ablation as a final treatment after achieving stability. This case highlights that thyroid storm encompasses symptoms that mimic acute cardiac crisis, thus underscoring the importance of prompt recognition and treatment of thyrotoxicosis to prevent severe cardiovascular sequelae.

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