Thyrotoxicosis and Moyamoya Syndrome: A Fatal Intersection of Rare Disorders in a Young Patient With a Background of Hypothyroidism
Abstract
Thyroid storm, also known as thyrotoxic crisis, is an uncommon and potentially life-threatening condition that can cause metabolic, cardiovascular and neurological complications. Thyrotoxic crisis often develops in the context of untreated or poorly controlled hyperthyroidism and is typically precipitated by acute stressors such as infection, surgery, or trauma. While the progression from hypothyroidism to hyperthyroidism is itself an uncommon clinical occurrence, the emergence of thyroid storm in this setting is sporadic. Such a case highlights the importance of being aware of atypical presentations of thyroid storm. The association between thyrotoxicosis and Moyamoya disease has been reported. There is no published case report or review describing Moyamoya syndrome in association with the transformation of hypothyroidism to hyperthyroidism. A 28-year-old patient with a known history of hypothyroidism, type 2 diabetes mellitus (T2DM) on SGLT2 inhibitors, polycystic ovarian syndrome (PCOS) and mixed anxiety-depressive disorder presented to the accident and emergency department with palpitations, chest discomfort and focal seizures reported by her partner and family. Initial blood tests showed euglycemic diabetic ketoacidosis (eDKA) and a very high thyroid function test suggestive of thyrotoxicosis. A CT of the brain showed a developing right frontal lobe infarct. The patient's condition continued to deteriorate despite ICU input. A repeat brain CT suggested Moyamoya…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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