A Perfect Storm in a Young Male: Ischemic Stroke and Thyroid Storm Unmasking Hyperthyroidism
Year: 2026
Type: article
Study design: Case Report
Abstract: Case RepoRtbilateral rales were noted.He was then intubated and transferred to the intensive care unit (ICU), and supportive treatment was started.Investigations revealed leukocytosis with neutrophilia, metabolic acidosis, high C-reactive protein, blood glucose, and creatinine levels (Table 1).Chest X-ray showed pulmonary congestion.Blood cultures were negative.ECG showed sinus tachycardia and left ventricular hypertrophy with a strain pattern.A repeat CT scan of the brain confirmed right temporoparietal occipital infarct with linear hyperdensity and midline shift to the left (Fig. 1).The patient's high fever, low blood pressure, tachycardia, and hypoxemia raised concern for sepsis leading to a diagnosis of ischemic stroke with septicemia and metabolic acidosis.He was started on broad-spectrum antibiotics with supportive treatment.A neurologist was consulted, and further investigations revealed high homocysteine, positive troponin I, and low TSH.An echocardiogram showed global hypokinesia with reduced ejection fraction (40-45%), leading to a diagnosis of stress cardiomyopathy.On the fourth day of admission, in view of the low TSH, an endocrinology opinion was sought.The patient was maintaining vital Key MessageIn a young stroke patient with sudden deterioration, it is imperative to rule out thyroid disorders even in the absence of atrial fibrillation, as early diagnosis and prompt aggressive simultaneous management of both diseases reduces morbidity and mortality significantly. IntroductIonHyperthyroidism presenting as ischemic stroke with thyroid storm is very rare.Ischemic stroke can be a precipitating factor for thyroid storm, or the thyroid storm may lead to arrhythmias and cardiomyopathy, which may lead to an ischemic stroke.The prevalence of hyperthyroidism is 1.3% in India. 1 Thyroid storm is an acute severe manifestation of thyrotoxicosis which is seen in approximately 1-2% of cases.It has a mortality of 10-30% in spite of advances in treatment.2,3 Here we describe the case of a young gentleman presenting with ischemic stroke and thyroid storm. case PresentatIonA 31-year-old nondiabetic, nonhypertensive gentleman presented with high-grade continuous fever, altered sensorium, left-sided paralysis, and breathlessness for 3 days.He had no history of headache, convulsions, palpitations, aura, vomiting, chest pain, dyspnea, or ear discharge.Three days earlier, he was completely healthy when he suddenly experienced dizziness followed by altered sensorium.He was previously admitted to another hospital, and his past medical history was insignificant.He did not use tobacco or alcohol.He was diagnosed with left hemiplegia, and the CT scan of his brain showed a right temporoparietal occipital infarct, for which he received thrombolysis with tenecteplase.Over the next 24 hours, his condition deteriorated, and he was transferred to our hospital under a neurosurgeon's care.Unfortunately, we had no access to his previous medical reports at the time of admission.On admission, he appeared thin and in distress.He had a high fever (104°F), tachycardia (140/minute, regular rhythm), hypotension, hypoxia, and E2V1M1.On pulmonary examination,
Authors: Shalini Pandya, Paresh G Mody
Institution: Sterling Hospitals
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7203553735