Tyhroid Storm-Induced Worsening Acute Myocardial Infarction: A Case Report

Background: As a true endocrine emergency, thyroid storm is rarely associated with acute myocardial infarction. However Graves’ disease is the most common underlying cause of thyroid storm. Clinical Case: A 47-year women experienced typical chest pain since 30 minutes before visited emergency room. The patient had type two diabetes as a cardiovascular risk factor and regularly took metformin thrice daily. The electrocardiogram showed non-ST segment elevation in leads I, V4-V6. Coronary arteriography showed stenosis in the three and left main vessels (70% stenosis of right coronary, 80% stenosis of left circumflex, 90% stenosis of left anterior descendent, and 90% stenosis of mid distal, in left main stem) then the patient was planned to do bypass surgery. At day 6 of hospitalization, the typical chest pain was worsening, epigastric pain became more painful, had 5 times diarrhea per day, high grade fever (>38.5oC), severe nausea and vomiting, then generalized tonic clonic seizure and respiratory failure was occurred. The patient was intubated in intensive care unit. Through a detail physical examination, a diffuse palpable thyroid enlargement and class I ophthalmopathy were found. Laboratory findings of free T4 was 2.23 ng/dL and Thyroid Stimulating Hormone (TSH) was 0.003 µIU/mL. The patient was assessed as thyroid storm then immediately, treated with three times of 100 mg hydrocortisone, two times of 20 mg of propranolol, and three times of 400 mg propylthiourasil. The patient’s clinical appearance was gradually recovered. After 3 days of treatment, she was extubated from ventilator. Two weeks later, no complaint of chest pain or epigastric pain in observation. Conclusion: Our case highlight the possibility that hyperthyroidism may be involved in the development of acute myocardial infarction.