This case study aims to discuss the unusual forms of hyperthyroidism presentation, the nonspecific symptoms and precipitating
events. A 70-year-old male was taken to the emergency department for hyperglycaemia, nausea, vomiting and altered mental status
with a week of evolution. He had a past medical history of type 2 diabetes, hypertension and dyslipidemia. He had no history of any
recent intercurrent illness or infection. At the emergency room, besides hyperglycaemia, ketonemia and slightly elevated C-reactive protein,
the basic laboratory panel workup was normal, as was the head computed tomography. He was admitted for metabolic compensation and
to study the altered neurological status. During hospitalisation, despite the good glycemic control, he had no improvements in neurological
status. At day four of hospitalisation, thyrotoxicosis with thyroid storm criteria was diagnosed. He started on adequate treatment with
complete clinical recovery. The associated morbidity and mortality of thyroid storm requires immediate recognition and treatment. Elderly
patients are frequently misdiagnosed or diagnosed later due to fewer and less pronounced signs and symptoms.
Thyroid storm, thyrotoxicosis, Graves’ disease,
type 2 diabetes, diabetic ketoacidosis, elderly
Ana Margarida Monteiro, Cláudia Matta-
Coelho, Vera Fernandes and Olinda Marques have
nothing to declare in relation to this article. The authors
have not received grants or scholarships. No funding
was received in the publication of this article.
This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any non-commercial use, distribution,
adaptation and reproduction provided the original
author(s) and source are given appropriate credit.
May 11, 2017 Accepted
June 29, 2017
Ana Margarida Monteiro,
Endocrinology Department of Hospital de Braga,
Sete Fontes – São Victor, 4710-243 Braga, Portugal.