Thyrotoxic Crisis and Disseminated Intravascular Coagulation (DIC) in a Healthy Young Patient Secondary to Sepsis, Presenting With Hyperpyrexia

Thyrotoxic crisis is an acute, rare, and potentially fatal complication of hyperthyroidism, associated with significant mortality and morbidity. Its occurrence is almost always precipitated by secondary triggers, and it can arise in both previously diagnosed and undiagnosed cases of hyperthyroidism. According to studies, nearly half of the patients presenting with thyrotoxic crisis had no prior diagnosis of thyroid disorder. Recognizing hyperpyrexia as a key presenting feature can be challenging for emergency physicians, as the initial focus is usually on stabilizing the patient rather than considering endocrine causes early in the evaluation. In view of the complications associated with thyrotoxic crisis, disseminated intravascular coagulation (DIC) is considered a rare but recognized manifestation. In this report, we present a case of a 39-year-old man who arrived at the emergency department with hyperpyrexia, altered mental status, and dyspnea. Initially, his airway was protected, stabilized, and managed with antipyretics, crystalloids, and external cooling measures. He also had features of sepsis and was admitted to the intensive care unit. Subsequently, he developed DIC, received appropriate treatment, and eventually made a full recovery. Since the diagnosis of thyrotoxic crisis is primarily based on clinical judgment, emergency physicians should consider it in the differential diagnosis of patients presenting with hyperpyrexia of unclear etiology. Although DIC is recognized as a rare complication of thyrotoxic crisis, the presence of coexisting sepsis made it challenging to determine whether the thyrotoxic crisis alone was the underlying cause. Therefore, we emphasize the need for further studies to clarify whether DIC in such scenarios arises from thyrotoxic crisis, sepsis, or a combination of both.