Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8768-8774
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8768
High scored thyroid storm after stomach cancer perforation: A case report
Seung Min Baik, Yejune Pae, Jae-Myeong Lee
Seung Min Baik, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul 07985, South Korea
Seung Min Baik, Yejune Pae, Department of Surgery, College of Medicine, Graduate School of Korea University, Seoul 02841, South Korea
Jae-Myeong Lee, Department of Acute Care Surgery, Korea University Anam Hospital, Seoul 02841, South Korea
Author contributions: Lee JM and Baik SM designed the research study; Lee JM, Baik SM and Pae Y performed the research, analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: The study was approved by the Institutional Review Board (IRB) (approval number: 2021AN0281) and waived the informed consents due to the retrospective study.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this work.
CARE Checklist (2016) statement: All authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jae-Myeong Lee, PhD, Associate Professor, Department of Acute Care Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea. ljm3225@hanmail.net
Received: April 4, 2022
Peer-review started: April 4, 2022
First decision: June 16, 2022
Revised: June 20, 2022
Accepted: July 8, 2022
Article in press: July 8, 2022
Published online: August 26, 2022
Processing time: 133 Days and 17.5 Hours
Abstract
BACKGROUND

Thyroid storm is a life-threatening emergency. Reportedly, the prevalence of thyroid storm is 1%-2% among patients admitted to the hospital for thyrotoxicosis. Burch and Wartofsky (1993) introduced a scoring system using precise clinical criteria to identify thyroid storms. Only 17 cases of thyroid storm with a score > 70 points have been reported. Although thyroid storms are uncommon, their clinical findings resemble those of sepsis.

CASE SUMMARY

A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation; medications for hypertension, diabetes mellitus, and hyperthyroidism had been suspended 1 year prior to this visit. We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation, and the patient was referred to the surgical intensive care unit (ICU). On the 2nd d in the ICU, his body temperature (BT) increased to 41.3 °C at 19:00, with the thyroid storm score (90 points) peaking at 18:00 (BT; 41.2ºC, pulse rate; 138/min, irritable status). The patient was administered propylthiouracil, intravenous glucocorticoids, acetaminophen, and Lugol’s solution daily. Subsequently, we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT. His vital signs were stable on the 8th day in the ICU.

CONCLUSION

Thyroid storms are uncommon, with few reports in the literature; however, their clinical findings resemble those of sepsis and require further investigation. Since an untreated thyroid storm results in a high mortality rate, it should be investigated when managing sepsis.

Keywords: Thyroid storm; Stomach cancer; Severity score; Sepsis; Case report

Core Tip: Since thyroid storm is a life-threatening emergency and mortality is high when treatment is delayed, thyroid function evaluation should not be overlooked when managing sepsis.