title: When the storm passes unnoticed--a case series of thyroid storm.
abstract: BACKGROUND
  Thyroid crisis is an acute manifestation of thyrotoxicosis. Approximately 1-2% of patients progress to a thyroid storm, often precipitated by a physiologically stressful event. If unrecognized or left untreated, thyroid storm may result in cardiovascular collapse and death.
  
  
  OBJECTIVE
  We describe three patients who presented to the Emergency Department of Singapore General Hospital in a thyroid storm. They had complications of thyrocardiac disease with heart failure and arrhythmias.
  
  
  METHODS
  An analysis of case records of patients presenting to the emergency department of Singapore General Hospital with a primary diagnosis of thyrotoxicosis was made over the period of 2004-2005. Three patients with thyroid storm were identified. All the patients presented heart failure and cardiac arrhythmias (1 atrial flutter, 2 atrial fibrillation).
  
  
  CONCLUSIONS
  Thyroid storm is a rare manifestation of thyrotoxicosis, usually occurring in females during the third to sixth decades of life. Serious complications such as heart failure and hypotension resulting in cardiovascular collapse and death may occur. Our case series consists of young males presenting with thyrocardiac failure. One patient was treated with beta-blockers and another with calcium channel blockers. Both developed cardiovascular collapse. The third patient was managed with digoxin with a good outcome. The current pathophysiology and therapeutic options are explored. A high index of suspicion should be maintained in young males presenting with heart failure and arrhythmia.
authors.affiliation: Singapore General Hospital, Department of Emergency Medicine, 3rd Hospital Avenue, Outram Raod, Singapore.
authors.forename: Su Yin Adeline
authors.initials: SY
authors.lastname: Ngo
authors.forename: Huck Chin
authors.initials: HC
authors.lastname: Chew
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D013958:Thyroid Crisis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy