title: Thyroid storm complicated by fulminant hepatic failure: case report and literature review.
abstract: OBJECTIVE
  Thyroid storm is a presentation of severe thyrotoxicosis that has a mortality rate of up to 20% to 30%. Fulminant hepatic failure (FHF) entails encephalopathy with severe coagulopathy in the setting of liver disease. It carries a high mortality rate, with an approximately 60% rate of overall survival for patients who undergo orthotopic liver transplantation (OLT). Fulminant hepatic failure is a rare but serious complication of thyroid storm. There have been only 6 previously reported cases of FHF with thyroid storm.
  
  
  METHODS
  We present a patient from our institution with thyroid storm and FHF. A literature review was performed to analyze the outcomes of the 6 additional cases of concomitant thyroid storm and FHF.
  
  
  RESULTS
  Our patient underwent thyroidectomy followed by OLT. Her serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, and transaminase normalized, and she was ready for discharge within 10 days of surgery. She has survived without complication. There is a 40% mortality rate for the reported patients treated medically with these conditions. Of the 7 total cases of reported FHF and thyroid storm, 2 patients died. Only 2 of the 7 patients underwent thyroidectomy and OLT--both at our institution. Both patients survived without complications.
  
  
  CONCLUSIONS
  Thyroid storm and FHF each independently carry high mortality rates, and managing patients with both conditions simultaneously is an extraordinary challenge. These cases should compel clinicians to investigate liver function in hyperthyroid patients and to be wary of its rapid decline in patients who present in thyroid storm with symptoms of liver dysfunction. Patients with rapidly progressing thyroid storm and FHF should be considered for total thyroidectomy and OLT.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hambleton
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Buell
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Bob
authors.initials: B
authors.lastname: Saggi
authors.affiliation: Department of Gastroenterology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Balart
authors.affiliation: Department of Gastroenterology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Shores
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D013958:Thyroid Crisis / Q000150:complications* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult