title: Thyroid storm caused by a chinese herb contaminated with thyroid hormones.
abstract: BACKGROUND
  We report a case of thyroid storm caused by consuming a Chinese herb contaminated with thyroid hormones.
  
  
  METHODS
  A 70-year-old man presented to an emergency department after 2 days of nausea, vomiting, and weakness. Three days previously, he had started taking Cordyceps powder and "Flower Man Sang Hung" as recommended by his Chinese physician. Following admission, the patient deteriorated and was eventually diagnosed with thyroid storm complicated by rapid atrial fibrillation requiring cardioversion, intubation, and intensive care admission. The analysis of the Chinese herb "Flower Man Sang Hung" was positive for levothyroxine. The patient was extubated 11 days after admission and discharged to a rehabilitation centre after 17 days of hospitalization. The Chinese medicine physician was informed of the events.
  
  
  CONCLUSIONS
  Herbal products can be the source of illness, medication interactions, and contamination. Awareness should be raised among Chinese medicine physicians, allopathic physicians, and their patients. Clinicians should also have a low threshold of suspicion to seek laboratory analysis of suspect substances when the cause of the clinical presentation is unclear.
authors: Department of Clinical Pharmacology and Toxicology, Fellow for the Ontario & Manitoba Poison Centre, University of Toronto, Intensivist Clinical Associate for the Department of Critical Care Medicine at the Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors: Maude
authors: M
authors: St-Onge
authors: Department of Laboratory Medicine, St. Michael Hospital, Toronto, ON, Canada.
authors: Hilde
authors: H
authors: Vandenberghe
authors: Ontario & Manitoba Poison Centre, Program Director of the Clinical Pharmacology and Toxicology program at the University of Toronto, University of Toronto, Toronto, ON, Canada.
authors: Margaret
authors: M
authors: Thompson
mesh_terms: D000368:Aged; D004338:Drug Combinations; D004365:Drugs, Chinese Herbal / Q000506:poisoning*; D006801:Humans; D008297:Male; D013958:Thyroid Crisis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D013963:Thyroid Hormones / Q000097:blood; D013974:Thyroxine / Q000506:poisoning*
chemical_list: D004338:Drug Combinations; D004365:Drugs, Chinese Herbal; D013963:Thyroid Hormones; D013974:Thyroxine
references: Breast Care (Basel). 2014 Feb;9(1):60-3
references: 24803889
references: Urology. 2003 Nov;62(5):849-53
references: 14624907
references: Ther Drug Monit. 2014 Aug;36(4):413-22
references: 24452064
references: Pathology. 2013 Feb;45(2):185-6
references: 23250039
references: PLoS One. 2012;7(11):e49676
references: 23185404
references: Clin Toxicol (Phila). 2008 Apr;46(4):290-2
references: 18363120
references: J Pharm Pharm Sci. 2011;14(1):1-16
references: 21501549
references: PLoS One. 2012;7(9):e45196
references: 23028841