title: Atrial fibrillation from thyroid storm.
abstract: BACKGROUND
  Thyroid storm is an often-discussed but rare presentation to emergency departments (EDs). The clinical presentation of a thyroid storm is the result of a hyperthyroid state that may result in significant morbidity or disability, or even death. Typically, patients are aware of their hyperthyroid condition, and may be able to recognize an episode of thyroid storm. However, the first presentation of hyperthyroidism could, in fact, be from thyrotoxic crisis.
  
  
  OBJECTIVE
  To review the presentation of thyroid storm, including tachycardia, hyperpyrexia, agitation, and altered mental status, which can be easily misdiagnosed as drug intoxication.
  
  
  METHODS
  We present the case of an otherwise healthy young adult who was sent to the ED by an outpatient care provider for generalized and vague symptoms of "feeling unwell" that was eventually diagnosed in the ED as thyrotoxic crisis.
  
  
  CONCLUSIONS
  We use this case to emphasize that thyrotoxic crisis should be at least considered in the differential diagnosis of a patient with this presentation, and to highlight how, even with apparently usual and effective treatments, a patient may still decompensate.
authors.affiliation: University of California-San Francisco, San Francisco, California 94110, USA.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Martinez-Diaz
authors.forename: Carl
authors.initials: C
authors.lastname: Formaker
authors.forename: Renee
authors.initials: R
authors.lastname: Hsia
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D013958:Thyroid Crisis / Q000150:complications* / Q000175:diagnosis