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June 27, 1980

Apathetic Thyroid Storm Associated With Anasarca and Thrombocytopenia

JAMA. 1980;243(24):2485. doi:10.1001/jama.1980.03300500013014

To the Editor.—  The diagnosis of hyperthyroidism is usually apparent after a careful history and physical examination; however, on occasion the diagnosis may be elusive and difficult to make. We describe a patient experiencing thyroid storm with anasarca, high-output heart failure, atrial fibrillation, stupor, hypoalbuminemia, and thrombocytopenia.

Report of a Case.—  A 52-year-old man had a four-month history of progressive weight loss, anasarca, and weakness. Four days before admission the patient experienced fever, progressive dyspnea, and a depressed level of consciousness, slipping into stupor at the time of admission. He was in atrial fibrillation at a rate of 180 beats per minute and was pyrexial and tachypneic. Severe anasarca and muscle wasting were present. Edema extended to his neck, and the thyroid gland was not palpable. His cardiac output was 12.6 L/min. Supportive care was instituted together with antibiotic therapy for a right lower lobe pneumonia.On the fourth day