Coma and Thyroid Storm in Apathetic Thyrotoxicosis

Michel W. Ghobrial, MD, and Edward B. Ruby, MD


South Med J. 2002;95(5) 

In This Article

Abstract and Introduction

We report the case of an 87-year-old woman with coma who was found to be in thyrotoxic crisis. The patient had a recent history of decreased mentation and apathy, and laboratory findings were found to be consistent with hyperthyroidism. After a stormy course, the clinical condition recovered to baseline, with return of laboratory values to normal following antithyroid therapy. We provide the details of this rarely documented presentation of apathetic hyperthyroidism with thyroid storm and coma and review the characteristics of similar cases in the literature.

Thyroid storm is a relatively rare, yet potentially fatal syndrome. It can only be differentiated from uncomplicated thyrotoxicosis on clinical basis, as laboratory findings are indistinguishable in both conditions.[1,2,3] It represents exaggerated clinical features of thyrotoxicosis that can rapidly be fatal unless recognized early and treated aggressively.[3]

Several atypical features for thyroid storm have been reported, of which apathy and coma are extremely rare. To the best of our knowledge, ours is only the second case in the worldwide literature and the first documented in the United States of apathetic thyrotoxicosis manifesting as thyroid storm and coma. We also found seven cases of thyrotoxic crisis in which coma was the initial manifestation and only six cases of apathetic thyrotoxicosis manifesting as thyroid storm.