Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease

Background: Radiation thyroiditis is a known complication of radioactive iodine therapy (RAI) resulting in mild exacerbation of thyrotoxic symptoms. However, thyroid storm following RAI is rare. Case Reports: Case 1: A 33-year-old lady with long standing Grave’s thyrotoxicosis was given 15mCi o...

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Main Authors:	M., Azura Dina, AW, Norasyikin, Sukor, Norlela, Mustafa, Norlaila, WS, Wan Juani, Shahar, Mohammad Arif, Omar, Ahmad Marzuki, R, Subashini, Loh, Huai Heng, O, Mohd Rahman, Kamaruddin, Nor Azmi
Format:	Article
Language:	English
Published:	Malaysian Endocrine and Metabolic Society 2014
Subjects:	RC Internal medicine
Online Access:	http://irep.iium.edu.my/48161/ http://irep.iium.edu.my/48161/ http://irep.iium.edu.my/48161/6/PP-036.pdf

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recordtype	eprints
spelling	iium-481612018-06-12T03:02:09Z http://irep.iium.edu.my/48161/ Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease M., Azura Dina AW, Norasyikin Sukor, Norlela Mustafa, Norlaila WS, Wan Juani Shahar, Mohammad Arif Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng O, Mohd Rahman Kamaruddin, Nor Azmi RC Internal medicine Background: Radiation thyroiditis is a known complication of radioactive iodine therapy (RAI) resulting in mild exacerbation of thyrotoxic symptoms. However, thyroid storm following RAI is rare. Case Reports: Case 1: A 33-year-old lady with long standing Grave’s thyrotoxicosis was given 15mCi of radioiodine 1-131 and developed worsening palpitation, sweating, tremor, fever, vomiting and diarrhea two days after treatment. At presentation, she had tremor and severe diaphoresis with heart rate of 141bpm and temperature of 39.8oC. She had small diffuse goiter and her weight was 54kg with BMI of 21.4kg/m2. There was no arrhythmia or heart failure and other systems examination was unremarkable. Her thyroid function test showed TSH <0.01uIU/ml, FT4 65.43pmol/l and FT3 28.09pmol/l. Her Burch-Wartofsky score was 70. She was treated as thyroid storm and as her blood culture was positive for E.coli she was given intravenous Ceftriaxone 1g OD. She made full recovery following treatment with lugol’s iodine, prophylthiouracil, propranolol, hydrocortisone and adequate hydration. Case 2: A 16-year-old girl with persistent thyrotoxicosis since 2010 presented five days after given 15mCi of RAI as her family noted that she progressively became irritable, restless and insomniac. These were associated with vomiting and diarrhea. At presentation, GCS was 12/15 with heart rate 110bpm and temperature 37oC. There was no palpable goiter and her weight was 55kg with BMI of 21.5kg/m2.There was no meningism or focal neurological deficit and other system examination was unremarkable. Her thyroid function test showed TSH <0.01uIU/ml, FT4 >77.22pmol/l and FT3 >46.08pmol/l. Her Burch-Wartofsky score was 55. Full neurological recovery occurred after 72 hours of treatment with hydration, lugol’s iodine, methimazole, propranolol and dexamethasone. Discussion: For the first case, the thyroid storm could be precipitated by the E.Coli infection. Her previous medical record showed history of lowgrade squamous intraepithelial lesion of the cervix, which usually precedes cytoplasmic intraepithelial neoplasia of the cervix. No plausible cause was found for the second case. Other possible causes that may contribute to the occurrence of the storm in these cases was usage of high doses of iodine 131 in relatively low BMI patients with small or no goiter. As the patients were given radioiodine within two consecutive days, the quality and integrity of the radioiodine substance maybe a factor contributing to this phenomenon. Comment: Although rare, thyroid storm can be precipitated by RAI and it is mostly severe and can be fatal. Malaysian Endocrine and Metabolic Society 2014-05 Article PeerReviewed application/pdf en http://irep.iium.edu.my/48161/6/PP-036.pdf M., Azura Dina and AW, Norasyikin and Sukor, Norlela and Mustafa, Norlaila and WS, Wan Juani and Shahar, Mohammad Arif and Omar, Ahmad Marzuki and R, Subashini and Loh, Huai Heng and O, Mohd Rahman and Kamaruddin, Nor Azmi (2014) Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease. Journal of Endocrinology and Metabolism, 4 (1(Sup)). p. 27. ISSN 2229-9572 http://www.jmems.org/index.php/jmems/issue/view/5
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC Internal medicine
spellingShingle	RC Internal medicine M., Azura Dina AW, Norasyikin Sukor, Norlela Mustafa, Norlaila WS, Wan Juani Shahar, Mohammad Arif Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng O, Mohd Rahman Kamaruddin, Nor Azmi Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
description	Background: Radiation thyroiditis is a known complication of radioactive iodine therapy (RAI) resulting in mild exacerbation of thyrotoxic symptoms. However, thyroid storm following RAI is rare. Case Reports: Case 1: A 33-year-old lady with long standing Grave’s thyrotoxicosis was given 15mCi of radioiodine 1-131 and developed worsening palpitation, sweating, tremor, fever, vomiting and diarrhea two days after treatment. At presentation, she had tremor and severe diaphoresis with heart rate of 141bpm and temperature of 39.8oC. She had small diffuse goiter and her weight was 54kg with BMI of 21.4kg/m2. There was no arrhythmia or heart failure and other systems examination was unremarkable. Her thyroid function test showed TSH <0.01uIU/ml, FT4 65.43pmol/l and FT3 28.09pmol/l. Her Burch-Wartofsky score was 70. She was treated as thyroid storm and as her blood culture was positive for E.coli she was given intravenous Ceftriaxone 1g OD. She made full recovery following treatment with lugol’s iodine, prophylthiouracil, propranolol, hydrocortisone and adequate hydration. Case 2: A 16-year-old girl with persistent thyrotoxicosis since 2010 presented five days after given 15mCi of RAI as her family noted that she progressively became irritable, restless and insomniac. These were associated with vomiting and diarrhea. At presentation, GCS was 12/15 with heart rate 110bpm and temperature 37oC. There was no palpable goiter and her weight was 55kg with BMI of 21.5kg/m2.There was no meningism or focal neurological deficit and other system examination was unremarkable. Her thyroid function test showed TSH <0.01uIU/ml, FT4 >77.22pmol/l and FT3 >46.08pmol/l. Her Burch-Wartofsky score was 55. Full neurological recovery occurred after 72 hours of treatment with hydration, lugol’s iodine, methimazole, propranolol and dexamethasone. Discussion: For the first case, the thyroid storm could be precipitated by the E.Coli infection. Her previous medical record showed history of lowgrade squamous intraepithelial lesion of the cervix, which usually precedes cytoplasmic intraepithelial neoplasia of the cervix. No plausible cause was found for the second case. Other possible causes that may contribute to the occurrence of the storm in these cases was usage of high doses of iodine 131 in relatively low BMI patients with small or no goiter. As the patients were given radioiodine within two consecutive days, the quality and integrity of the radioiodine substance maybe a factor contributing to this phenomenon. Comment: Although rare, thyroid storm can be precipitated by RAI and it is mostly severe and can be fatal.
format	Article
author	M., Azura Dina AW, Norasyikin Sukor, Norlela Mustafa, Norlaila WS, Wan Juani Shahar, Mohammad Arif Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng O, Mohd Rahman Kamaruddin, Nor Azmi
author_facet	M., Azura Dina AW, Norasyikin Sukor, Norlela Mustafa, Norlaila WS, Wan Juani Shahar, Mohammad Arif Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng O, Mohd Rahman Kamaruddin, Nor Azmi
author_sort	M., Azura Dina
title	Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
title_short	Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
title_full	Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
title_fullStr	Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
title_full_unstemmed	Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease
title_sort	two consecutive cases of thyroid storm following radioactive iodine therapy for grave’s disease
publisher	Malaysian Endocrine and Metabolic Society
publishDate	2014
url	http://irep.iium.edu.my/48161/ http://irep.iium.edu.my/48161/ http://irep.iium.edu.my/48161/6/PP-036.pdf
first_indexed	2023-09-18T21:08:23Z
last_indexed	2023-09-18T21:08:23Z
_version_	1777411086899740672

Two consecutive cases of thyroid storm following radioactive iodine therapy for Grave’s disease

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