Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report
Dublin Core
Title
Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report
Subject
Subarachnoid hemorrhage, Thyroid storm, Tachycardia
Description
Background Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagno-
sis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent suba-
rachnoid hemorrhage and thyroid storm we encountered at our hospital.
Case presentation The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden
disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were
Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrilla-
tion (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemor-
rhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal
carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and
free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thia-
mazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia,
the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treat-
ment. The treatment was successful as the patient’s symptoms improved, and she became lucid.
In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage
induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely
occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of
the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is
possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as
per patient’s condition.
Conclusion If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend
considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid
storm is present, we believe that a treatment plan tailored to the patient’s condition is critical, and early diagnosis will
lead to a favorable outcome for the patient.
sis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent suba-
rachnoid hemorrhage and thyroid storm we encountered at our hospital.
Case presentation The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden
disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were
Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrilla-
tion (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemor-
rhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal
carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and
free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thia-
mazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia,
the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treat-
ment. The treatment was successful as the patient’s symptoms improved, and she became lucid.
In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage
induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely
occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of
the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is
possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as
per patient’s condition.
Conclusion If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend
considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid
storm is present, we believe that a treatment plan tailored to the patient’s condition is critical, and early diagnosis will
lead to a favorable outcome for the patient.
Creator
Aimi Ohya1†, Makoto Ohtake1,2*†, Yusuke Kawamura1
, Taisuke Akimoto2
, Masayuki Iwashita1
,
Tetsuya Yamamoto3 and Ichiro Takeuchi1
, Taisuke Akimoto2
, Masayuki Iwashita1
,
Tetsuya Yamamoto3 and Ichiro Takeuchi1
Source
https://doi.org/10.1186/s12245-023-00490-4
Date
2023
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Aimi Ohya1†, Makoto Ohtake1,2*†, Yusuke Kawamura1
, Taisuke Akimoto2
, Masayuki Iwashita1
,
Tetsuya Yamamoto3 and Ichiro Takeuchi1, “Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report,” Repository Horizon University Indonesia, accessed April 26, 2026, https://repository.horizon.ac.id/items/show/12119.