title: Recurrent thyroid storm induced by heretofore unrecognised causes in a patient with thyroid cancer.
abstract: An unusual encounter of a thyroid storm, on two separate occasions, is reported in a patient with metastatic differentiated thyroid cancer following initially direct trauma to, and later tumour embolisation of, a metastatic skeletal lesion. Shortly after a fall, our patient presented with pain and swelling in the right shoulder, high fever, change in mental status, anorexia, nausea and vomiting, tachycardia and dehydration. The laboratory tests were consistent with hyperthyroidism. As the patient improved, arterial embolisation of the large right humerus metastasis was performed to decrease the tumour burden. The patient, however, developed a similar clinical and biochemical picture to that at her presentation, with a very high free thyroxine (T(4)) level, a few days after successful embolisation. Treatment of the thyroid storm was initiated and the patient eventually improved. Awareness of such occurrences is helpful in early diagnosis and effective management of this potentially fatal complication.
authors.affiliation: King Faisal Specialist Hospital, Medicine, MBC 46, Box 3354, Takassusi Street, Riaydh, 11211, Saudi Arabia.
authors.forename: Hussein
authors.initials: H
authors.lastname: Raef
authors.forename: Talal
authors.initials: T
authors.lastname: Dahhan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ahmed
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mubarak
authors.forename: Taquir
authors.initials: T
authors.lastname: Rana
authors.forename: Asma
authors.initials: A
authors.lastname: Tulba