Thyroid Storm: A Forgotten Cause of Arrhythmias with Septic Feature

Hyperthyroidism is the condition resulting from the effect of excessive amounts of thyroid hormones on body tissues. A dramatic extreme expression of thyrotoxicosis known as thyroid strom occurs rarely but requires prompt recognition and intervention to avoid the 90 percent mortality of untreated disease. Characteristically the patient present with fever, rapid tachyarrhythmias and atrial fibrillation. High output congestive heart failure can result from the tachycardia and severe hypermetabolic state. Frequently the clinical picture is clouded by a secondary infection such as pneumonia, a viral infection, or infection of the upper respiratory tract. Because of its variable presentation and because thyroid storm is rare condition, the correct diagnosis may be missed. We report two interesting cases of thyroid storm. The first was a lady who presented with a supraventricular tachycardia and atrial fibrillation initially misdiagnosed as septicemia with arrhythmias. The second case was a man with longstanding undiagnosed hyperthyroidism who presented with threatening thyroid storm and atrial fibrillation associated with cardiomyopathy. Both patients were subsequently managed successfully at our hospital. We hope misdiagnosis and late treatment of the similar cases will be avoided in the future.