English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Altered mental status (AMS) is a challenging symptom, commonly encountered in the acute hospital setting. We present a challenging case of AMS where an early assessment could have potentially prevented a complicated hospital course. A 42-year-old male presented to emergency room with chest pain. He was tachycardic, hypotensive and electrocardiogram showed new ST depressions. He underwent emergent cardiac catheterization showing triple vessel disease with placement of intra-aortic balloon pump, followed by CABG. Post-operatively he could not be extubated and had persistent fever, tachycardia and deterioration in mental status. Initial work up for fever and AMS was unremarkable. He was treated with broad spectrum antibiotics and beta blockers but remained intubated, febrile, and altered. Thyroid function tests done around second week of hospitalization revealed TSH < 0.03uU/ml, fT4 > 4.5 ng/dl, T3 411.9 ng/dl, thyroid stimulating immunoglobulin 269%. A thyroid sonogram revealed diffusely enlarged, heterogeneous and hypervascular thyroid lobes. He was started on stress doses of steroids, propylthiouracil and continued on beta blocker. Within the next 72 hours his heart rate, fever and mental status improved and he was extubated. Thyroid storm, also referred to as thyrotoxic crisis, is an acute life threatening hypermetabolic state induced by excessive release of thyroid hormones in a patient with thyrotoxicosis. It is often precipitated by an acute event such as surgery, trauma, infection or iodine load. The Burch and Wartofsky scoring system is helpful in distinguishing this from severe thyrotoxicosis. It should always be kept in the differential diagnosis of AMS, fever, tachycardia of unknown cause.

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss