Open AccessSerotonin syndrome unmasking thyrotoxicosis
Author(s) -
Geoffrey Peter Ronan,
N.J. Ronan,
Siobhán McGettigan,
Gemma Browne
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-228404
Subject(s) - medicine , delirium , serotonin syndrome , sedation , intensive care unit , anesthesia , otorhinolaryngology , pediatrics , dysphagia , intensive care medicine , psychiatry , surgery , serotonin , receptor , serotonergic
A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.