A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man

ABSTRACT Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac involvement is the leading cause of death in patients with thyroid storm. We report a unique case of thyroid storm precipitated by viral myopericarditis in the setting of exogenous thyroid hormone supplementation. Methods: Case report and review of the literature. Results: We report a case of a previously healthy 26-year-old male with a history of bodybuilding who developed thyroid storm with multi-organ failure, including acute-onset congestive heart failure, leading to cardiogenic shock. Investigations revealed ingestion of exogenous thyroid hormone as the source of his thyrotoxicosis. Initial labs revealed serum thyroid-stimulating hormone 0.015 mU/L, free thyroxine 2.3 ng/dL, free triiodothyronine 8.8 pg/mL, total triiodothyronine of 2.22 ng/mL, and thyroglobulin 4.4 ng/mL. There was also evidence of viral myopericarditis, as demonstrated on cardiac imaging and multiple elevated Coxsackie virus B titer levels. Conclusion: Given the patient's underlying thyrotoxic state from exogenous thyroid hormone ingestion, we believe that his acute myopericarditis was the catalyst that precipitated his thyroid storm. The combination of acute myopericarditis and thyroid storm ultimately led to cardiogenic shock. He showed rapid improvement with cardiopulmonary supportive efforts and treatment for thyroid storm. In considering the etiology of thyroid storm, it is important to exclude the possibility of exogenous thyroid hormone ingestion, especially in the setting of nonregulated, over-the-counter, bodybuilding, or weight-loss supplement use. Abbreviations: MRI = magnetic resonance imaging; SSKI = supersaturated potassium iodide; T3 = triiodothyronine; T4 = thyroxine