Thyroid Storm Precipitated by Medication Non-adherence and Infection Presenting with Proximal Myopathy: A Case Report

Abstract

Thyroid storm is  life-threatening endocrine emergency .It requires early recognition and aggressive management. A 59-year-old female with long-standing multinodular goitre, presented with complaints of fever, diarrhoea, palpitations, leg swelling and progressive weakness& poor compliance to antithyroid medications. On examination she was febrile, tachycardiac, with bilateral proptosis and multinodular goitre. Laboratory investigations revealed severe thyrotoxicosis. A Burch–Warsofsky score >45(65) supported the diagnosis of thyroid storm.

She was managed with beta-blockers, antithyroid drugs, corticosteroids, insulin infusion, and broad-spectrum antibiotics. she initially showed clinical improvement with treatment and developed sudden respiratory distress requiring mechanical ventilation. With intensive care support, she subsequently improved and recovered.

Our case highlights the critical importance of medication adherence in hyperthyroid patients and demonstrates that thyroid storm may deteriorate despite apparent biochemical improvement, necessitating vigilant monitoring and timely escalation of care.