Open AccessInitiation of levothyroxine in a patient with hypothyroidism inducing adrenal crisis requiring VA ECMO: a tale of preventable disaster
Author(s) -
Mandip Kang,
Charnjeet Sandhu,
Natasha Ramroop Singh,
Timothy Evans
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-2019-230601
Subject(s) - medicine , levothyroxine , extracorporeal membrane oxygenation , pulseless electrical activity , emergency department , adrenal crisis , past medical history , nausea , pediatrics , adrenal insufficiency , cardiopulmonary resuscitation , anesthesia , thyroid , resuscitation , psychiatry
A 31-year-old man with a recent diagnosis of hypothyroidism presented to the emergency department as a transfer from the clinic for severe hypotension and hypoglycaemia. The patient endorsed a 2-week history of severe fatigue, weight loss, nausea and non-bloody emesis. He was aggressively hydrated and vasopressors were initiated. Despite these measures, the patient remained hypotensive and went into pulseless electrical activity. Return of spontaneous circulation was achieved via advanced cardiac life support protocol, and venous arterial extracorporeal membrane oxygenation (ECMO) was initiated. On day 3 of hospitalisation, the patient was weaned off ECMO support, and subsequent autoimmune work-up confirmed the diagnosis of autoimmune polyglandular syndrome type 2 with positive antiperoxidase antibodies (267 IU/mL), supporting the diagnosis of Hashimoto's thyroiditis.