J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 10, Number 4, April 2018, pages 351-357

Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review

Figures

Figure 1. EKG on admission showed sinus tachycardia (heart rate: 149 bpm) and left atrial abnormality.

Figure 2. Chest X-ray on admission (a) revealed extensive bilateral airspace disease compatible with pulmonary edema, which significantly cleared up on the second day of admission (b).

Figure 3. Ultrasound detected multiple nodules in thyroid gland.

Figure 4. Thyroid scan revealed hot spots in thyroid glands.

Tables

**Table 1.** Arterial Blood Gas Test Results 30 min After Intubation
Arterial blood gas	Result	Normal range
pH	7.17	7.35 - 7.45
PCO₂	62.3	35.0 - 45.0 mm Hg
PO₂	314.0	75.0 - 100.0 mm Hg
HCO₃	22.1	23.0 - 28.0 mmol/L
O₂ sat	99.7%	94-98%
FiO₂	100%
A-a gradient	328.7

**Table 2.** Laboratory Findings
Test	Result	Normal Range
AGP: anion gap; BNP: brain natriuretic peptide; CK: creatinine phosphokinase; GFRAA: estimated glomerular filtration rate for African American; HGB: hemoglobin; HCT: hematocrit; WBC: white blood cell.
Sodium	137	136 - 145 mEq/L
Potassium	3.8	3.5 - 5.1 mEq/L
Chloride	98	90 - 110 mEq/L
Bicarbonate	21	22 - 28 mEq/L
Blood urea nitrogen	9	6 - 20 mg/dL
Creatinine	0.6	0.5 - 0.9 mg/dL
Glucose	179	70 - 115 mg/dL
Calcium	10.7	8.6 - 10.2 mg/dL
Magnesium	1.7	1.7 - 2.5 mg/dL
AGP	19	2.6 - 10.6 mmol/L
GFRAA	> 60	≥ 60 mL/min/1.73 m²
Alkaline phosphatase	175	40 - 130 U/L
Troponin I	0.51 → 0.43 → 0.56	< 0.3 ng/mL
CK	47.0 → 83.0 → 67.0	20 - 200 ng/mL
CKMB	2.53 → 6.1 → 4.86	1.0 - 5.0 ng/mL
BNP	2,380.0	< 300
HGB	14.8	10.3 - 15.1
HCT	47.6%	31.2-45.4%
WBC	13.6	3.6 - 11.0
Platelet	233	150 - 372
Absolute lymphocyte	6.3	0.9 - 2.9

**Table 3.** Thyroid Panel
Tests	Results	Normal range
TPO Ab: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; TSAb: thyroid-stimulating antibody.
T3 total	269	71 - 180 ng/dL
T3 free	10	2.0 - 4.4 pg/mL
Free T4	5.05	0.82 - 1.77 ng/dL
TSH	0.005	0.45 - 4.50 µIU/mL
TPO Ab	67.0	0 - 34 IU/mL
TSAb	446	0-139%
TgAb	< 20	0 - 40 IU/mL
PTH	74	15 - 65 pg/mL