Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy
Table 2
The Akamizu criteria for the diagnosis of thyroid storm [5].
Prerequisite for diagnosis
(i) Presence of thyrotoxicosis with high free triiodothyronine (FT3) or free thyroxine (FT4)
Symptoms
(1) CNS manifestations: restlessness, delirium, psychosis, somnolence/lethargy, coma (≥1 on the Japan Coma Scale or ≤14 on the Glasgow Coma Scale)
(2) Fever: ≥38°C
(3) Tachycardia: ≥130 beats/minute or heart rate ≥130 in AF
(4) CHF: pulmonary oedema, crackles over > half of the lung field, cardiogenic shock, or class IV by the New York Heart Association or ≥ class III in the Killip classification
(5) GI/hepatic manifestations: nausea, vomiting, diarrhoea, or a total bilirubin ≥3 mg/dL
Diagnosis
TS grade
Combinations
Requirements for diagnosis
TS1
First combination
Thyrotoxicosis and at least 1 CNS manifestation and fever, tachycardia, CHF, or GI/hepatic manifestations
TS1
Alternate combination
Thyrotoxicosis and at least 3 combinations of fever, tachycardia, CHF, or GI/hepatic manifestations
TS2
First combination
Thyrotoxicosis and a combination of 2 of the following: fever, tachycardia, CHF, or GI/hepatic manifestations
TS2
Alternate combination
Patients who met the diagnosis of TS1 except that serum FT3 or FT4 level is not available
