Fatal Recurrent Cardioembolic Stroke Related to Thyroid Storm: A Case Report

Thyroid storm is a rare and life-threatening condition that develops in thyrotoxic patients with multiple systems involved. A 50-year-old woman with a history of hyperthyroidism and paroxysmal atrial fibrillation (AF) without regular treatment presented with acute left limb weakness and slurred speech. Electrocardiography indicated AF with a rapid ventricular rate of 165 beats per minute. Chest radiography revealed cardiomegaly with bilateral pleural effusion. The patient received thrombolytic therapy at 78 min after symptom onset. Brain computed tomography angiography revealed normal results. Laboratory tests revealed elevated free thyroxine, triiodothyronine, antithyroid-stimulating hormone (TSH) receptor antibody, and reduced TSH content. We immediately initiated intravenous digoxin, oral propranolol, and propylthiouracil. Echocardiography revealed global left ventricular hypokinesia. Recurrent fatal large infarction involving the bilateral hemispheres resulted in coma with quadriplegia on day 3. Thyroid storm should be diagnosed with early as possible. Simultaneous treatment of ischemic stroke and thyroid storm is challenging.