title: Thyroid Storm in a Patient with Trauma - A Challenging Diagnosis for the Emergency Physician: Case Report and Literature Review.
abstract: BACKGROUND
  Thyroid storm, an endocrine emergency, remains a diagnostic and therapeutic challenge. It is recognized to develop as a result of several factors, including infection, surgery, acute illness, and rarely, trauma. Recognition of thyroid storm in a trauma patient is difficult because the emergency physician usually focuses on managing more obvious injuries.
  
  
  OBJECTIVE
  We present a case of trauma-related thyroid storm and review the previous literature on posttraumatic thyroid storm to delineate risk factors of the disease. The case occurred in a 32-year-old man after a motorcycle accident.
  
  
  CONCLUSIONS
  Careful investigation of patient history and risk factors of trauma-related thyroid storms and utilization of the scoring system may facilitate early diagnosis. Traumatically induced thyroid storm usually responds to medical treatment developed for hyperthyroidism. Surgical intervention may be needed for patients who failed medical treatment or those with direct thyroid gland injuries. The outcome is usually fair under appropriate management.
  
  
  CONCLUSIONS
  We present a case of trauma-related thyroid storm to illustrate the diagnostic and therapeutic approach with a summary of the previous literature. Emergency physicians should be aware of the clinical presentation and risk factors of patients with trauma-related thyroid storm to reduce the rate of misdiagnosis and prevent catastrophic outcomes.
authors.affiliation: Department of Emergency Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan.
authors.forename: Hsiang-I
authors.initials: HI
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
authors.forename: Giou-Teng
authors.initials: GT
authors.lastname: Yiang
authors.affiliation: Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chin-Wang
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jen-Chun
authors.initials: JC
authors.lastname: Wang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chien-Hsing
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000002:abnormalities; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000628:therapy; D008297:Male; D012307:Risk Factors; D013610:Tachycardia / Q000209:etiology; D059246:Tachypnea / Q000209:etiology; D013958:Thyroid Crisis / Q000175:diagnosis* / Q000209:etiology*; D013960:Thyroid Function Tests; D014947:Wounds and Injuries / Q000150:complications*
keywords: emergency physician; hyperthyroidism; risk factors; thyroid storm; trauma