Email ruanyu2019@zju.edu.cn. Most cases of thyroid storm occur after a precipitating event, intercurrent illness, or discontinuation of antithyroid medication. Most patients become hypothyroid. College of Medicine, The University of Vermont, Burlington, VT, USA, H. N. Buch, “An unusual case of relapsing Graves' disease,”, R. B. Shafer and F. Q. Nuttall, “Thyroid crisis induced by radioactive iodine,”, M. T. McDermott, G. S. Kidd, L. E. Dodson Jr., and F. D. Hofeldt, “Radioiodine-induced thyroid storm. National Library of Medicine Contrast-induced hypothyroidism. Thyroid Storm and Complete Heart Block after Treatment with Radioactive Iodine, Division of Endocrinology and Diabetes, The Robert Larner, M.D. Radioiodine treatment for hyperthyroidism secondary to Graves’ disease has been shown to be safe and effective and remains the treatment of choice in North America. Relapse of Graves' disease months after inadequate treatment with 131I is well-recognized. The destruction of follicular cells within the thyroid gland results in the release of stored thyroid hormone into the circulation. Since the thyroid gland is critical to body functioning, damage to will affect all the organ systems of the body when there is a thyroid storm. We present a case of thyroid storm precipitated by radioiodine therapy and manifesting as heart block, both rare but life-threatening complications of treatment for hyperthyroidism. doi: 10.7759/cureus.14219. Thyroid storm is more common in Graves' disease and can be precipitated by surgery, trauma, infection, metabolic abnormalities, iodine load, and parturition. Privacy, Help Relative Adrenocortical Insufficiency Following Radioactive Iodine Therapy for Graves' Disease: A Report of Two Cases. This may sound extreme at first, but this vital medication is essentially doing the job of a healthy thyroid gland; it’s absolutely critical to bodily health. 2003;79(937):662-a–663. doi: 10.1136/pmj.79.937.662-a. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery. American Thyroid Association. Fact sheet: guidelines for patients receiving radioiodine I-131 treatment. I123 thyroid scan revealed elevated, diffuse uptake bilaterally, without nodules, consistent with the diagnosis of Graves’ disease. But unlike the mineral iodine, RAI will destroy the cells of … The lack of tachycardia can be explained by her complete heart block. Giving large levels of iodine can inhibit the release of thyroid hormone (called “Wolf-Chaikoff Effect”). Radioactive iodine ablation consists of swallowing radioactive iodine in the form of an ordinary sized capsule. They will tell you when the radioactivity has dropped to a safe level and you can go home. A 7.5-yr-old boy with Graves' disease, difficult to control with antithyroid medication and radioactive iodine (RAI) therapy, developed thyroid storm encephalopathy on day 13 after … -, Burch H. B., Solomon B. L., Cooper D. S., Ferguson P., Walpert N., Howard R. The Effect of Antithyroid Drug Pretreatment on Acute Changes in Thyroid Hormone Levels after. Radioactive iodine treatment is commonly recommended by endocrinologists as a "cure" for hyperthyroidism and Graves' Disease. The patient was treated with 11.9 mCi of radioactive iodine. This isn't always true, but it is true for MOST … INTRODUCTION. “Thyroid storm after radioactive iodine is extremely rare,” Dr. Vijayakumar concluded. Thyroid storm following radioactive iodine (RAI) therapy for hyperthyroidism may be related to (1) withdrawal of antithyroid medications for RAI administration (usually withdrawn 5-7 d before administration of RAI and held until 5-7 d after RAI therapy), (2) release of large amounts of thyroid hormone from damaged follicles, and (3) RAI itself. However, there continues to be no consensus on the diagnostic criteria for thyroid storm. A single injection is given subcutaneously (i.e. Medical College & K.E.M.H., Mumbai, Maharashtra Blood cultures revealed no microbial growth. An electrocardiogram (ECG) revealed accelerated junctional rhythm at a rate of 53 beats/min. Timely recognition of this atypical presentation of thyroid storm allowed prompt implementation of potentially life-saving treatment. The low rate of contrast-induced hyperthyroidism in the Italian study, conducted in an iodine-deficient region, was likely due to the use of antithyroid medications and/or radioactive iodine ablation before contrast exposure. Radioactive iodine. Email ruanyu2019@zju.edu.cn. One of the reasons that radio-iodine treatment is so effective is because the thyroid readily takes up iodine, which is used in thyroid hormone production. The clinical manifestations of thyroid storm promptly improved after … s L s. 9 Study Intervention and comparison Population Outcomes Comments 2021 May 3;14:1641-1646. doi: 10.2147/IJGM.S305454. -, McDermott M. T., Kidd G. S., Dodson L. E., Jr., Hofeldt F. D. Radioiodine-induced thyroid storm. Introduction: In recent years, radioactive iodine (RAI) therapy has become a main choice for Graves’ disease. The peripheral leukocyte count was 15.9 x 109 cells/L with no immature forms. Thyroid storm is a rare but severe and potentially life-threatening complication of hyperthyroidism (overactivity of the thyroid gland).It is characterized by a high fever (temperatures often above 40 °C/104 °F), fast and often irregular heart beat, elevated blood pressure, vomiting, diarrhea, and agitation. So it will travel through the bloodstream to the thyroid gland. The rapid release of thyroid hormones following RAI may on occasion trigger severe events, such as thyroid storm or heart block. Radioactive Iodine Testing Depending on the dose, radioactive iodine can kill a portion, or all, of your thyroid. We present a diagnostically challenging case of thyroid storm precipitated by radioiodine therapy and accompanied by bradycardia, a rare but life-threatening complication related to treatment for … There was evidence of an anion gap metabolic acidosis with a serum lactate concentration of 6.2 mmol/L. While many people who receive this treatment seem to do fine, others regret the decision to have received this treatment method. An ECG revealed no coexisting cardiac anomalies; she was not hypokalemic nor hypercalcemic and was not taking digoxin. During her stay in the intensive care unit, the patient exhibited fever (39.6°C maximum), tachycardia, and tremulousness. doi: 10.1210/jcem.86.7.7639. However, it has proven difficult to define the risk factors for development of thyroid storm after radioiodine administration. Pediatr Rev. These manifestations resolved over a period of 22 hours. The 1986 Chernobyl (Chornobyl in Ukrainian) nuclear power plant accident exposed millions of individuals in the surrounding region to radioactive contaminants, resulting in increased papillary thyroid carcinoma (PTC) incidence in radioactive iodine (131 I)–exposed children.Currently, no reliable biomarkers for radiation-induced cancers have been identified, and … Radioiodine therapy induces thyroiditis and subsequent fibrosis of the thyroid gland. A 19-year-old woman with Graves' disease developed thyroid storm 8 days after radioactive iodine therapy. We have a range of general information to help you understand more about this treatment, how it is used and how safe it is. However, in some cases, no underlying disease was identified and subsequent treatment of the thyrotoxicosis resulted in restoration of normal AV conduction [8, 9]. remaining thyroid tissue in the neck after a thyroid cancer operation. A publication of the American Thyroid Association . G G Wickus. Reported cases of thyroid storm in 10- to 19-yr-old patients occurred 2–8 days after iodine-131 ( 131 I) treatment. Radioactive Iodine I-131 (also called Radioiodine I-131) therapy is a treatment for an overactive thyroid, a condition called hyperthyroidism. The problem usually happens after a stressful event or a serious illness, such as a major infection. Sawka AM, Lea J, Alshehri B, et al. Hypothyroidism is a common side effect of RAI for hyperthyroidism and always seen after RAI for thyroid cancer. This is usually easily treated with thyroid hormone replacement (see Hypothyroidism brochure). After having treatment For a few days after radioactive iodine treatment, you will be slightly radioactive. American Journal of Medicine. Radioactive iodine has very little effect on other parts of the body. Weathering the Storm: Thyroid Storm Precipitated by Radioiodine Contrast in Metastatic Thyroid Carcinoma. Thyroid storm following radioactive iodine (RAI) therapy for pediatric graves disease. Updated May 28, 2019. Interestingly, our patient had none of the previously reported risk factors for development of complete heart block associated with thyrotoxicosis and thyroid storm. A radioactive iodine uptake test and thyroid scan together characterizes or enables radiologists and doctors to determine the cause of hyperthyroidism. The patient was endotracheally intubated and transferred via helicopter to our facility. Ablation of the gland occurs over 2-5 months after radioactive iodine therapy. Rohrs HJ 3rd, Silverstein JH, Weinstein DA, Amdur RJ, Haller MJ. Society of Nuclear Medicine & Molecular Imaging. Thyroid storm developed following radioiodine therapy in a 43-year-old man with Graves' disease, weight loss, myopathy, severe thyrotoxic hypercalcemia, and a pituitary adenoma. The destruction of follicular cells within the thyroid gland results in the rapid release of stored thyroid hormone into the circulation, which can serve as a precipitating event for thyroid storm in a very small percentage of patients. FOIA The patient was given atropine 0.5 mg intravenously without effect, followed by initiation of external cardiac pacing. There is a small but definite chance that radioactive iodine treatment may worsen already existing Graves ophthalmology or cause it. -, Matfin G. Endocrine and Metabolic Medical Emergencies. Was T4 47.00 prior to treatment, which dropped after 3 months to 12.4. We present a diagnostically challenging case of thyroid storm precipitated by radioiodine therapy and accompanied by bradycardia, a rare but life-threatening complication related to treatment for hyperthyroidism. Although hypothyroidism remains the most common complication of radioiodine therapy, more severe complications can occur. The hypercalcemia may have been a significant, and previously unreported, predisposing factor for the radioiodine-associated thyroid storm.

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