J Yeungnam Med Sci.  2023 Nov;40(Suppl):S93-S97. 10.12701/jyms.2023.00199.

Thyroid storm caused by metastatic papillary thyroid carcinoma tissue after total thyroidectomy: a case report

• Kwon SH
• Kim MJ
• Jung SY
• Jeon JH

• KMID: 2548348
• DOI: http://doi.org/10.12701/jyms.2023.00199

Abstract

Thyroid storm is a life-threatening form of thyrotoxicosis and an endocrinological emergency. We present a case of thyroid storm in a patient with metastatic papillary thyroid cancer. A 67-year-old woman with a history of total thyroidectomy 4 years prior to presentation was admitted with deteriorating mental status, fever, and tachycardia. Laboratory tests revealed severe thyrotoxicosis. Although the patient had no residual thyroid tissue after total thyroidectomy, she had a previously diagnosed metastatic thyroid cancer lesion in the pelvic bone. Despite initial treatment with a standard thyroid storm regimen, the patient died 6 days after hospitalization. The patient had no history of Graves disease; however, a thyroxine receptor antibody was detected postmortem. The patient had a history of exposure to an iodine contrast agent, which is a rare cause of thyrotoxicosis. Thyroxine production from a differentiated thyroid carcinoma is rare but can be a source of clinically significant thyrotoxicosis in patients post-thyroidectomy. Overlapping Graves disease is a common stimulus; however, other causes, such as exogenous iodine, cannot be excluded. This case demonstrates that in the setting of metastatic thyroid carcinoma, thyrotoxicosis cannot be completely ruled out as a cause of suspicious symptoms, even in patients with a history of total thyroidectomy.

Keyword

Thyroid neoplasms, papillary; Thyroid crisis; Thyrotoxicosis

Figure

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  Fig. 1. Serum free T4, total T3, and thyroglobulin levels throughout the course of treatment in our institution, with annotation of levothyroxine dosage and dates of iodine contrast computed tomography imaging. T4, thyroxine; T3, triiodothyronine.

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  Fig. 2. Results of medical imaging tests performed to the patient throughout the disease course. (A) Cervical ultrasonography of the thyroid bed shows no evidence of local recurrence in April 2018. (B) Positron emission tomography/computed tomography (PET/CT) scan of the thorax shows a single pulmonary nodule without fluorodeoxyglucose uptake (arrows) in April 2018 and May 2019. (C) PET/CT scan of the pelvis shows the progression of metastatic lesion in the left pubis (arrows) in April 2018, May 2019, and March 2021.

Reference

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