Exp Clin Endocrinol Diabetes 2007; 115(6): 392-396
DOI: 10.1055/s-2007-971065
Case Report

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Cardiovascular Collapse Associated with Beta Blockade in Thyroid Storm

R. Dalan 1 , M. Leow 1
  • 1Department of Endocrinology, Tan Tock Seng Hospital, Singapore
Further Information

Publication History

received 16. 7. 2006 first decision 12. 2. 2007

accepted 12. 2. 2007

Publication Date:
08 June 2007 (online)

Abstract

We describe three cases of thyroid storm who developed sudden cardiorespiratory arrest soon after the administration of propranolol orally.

Case 1: A 43 years old Chinese lady presented with complaints of fever and chills. She had a urinary tract infection and also had signs of overt thyrotoxicosis. She was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. Soon after propranolol was given orally she developed an asystolic cardiorespiratory arrest.

Case 2: A 72 years old Chinese gentleman presented with confusion, fever and rapid atrial fibrillation. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. He developed a cardiorespiratory arrest about 6 hours after commencement of therapy.

Case 3: A 48-year-old Chinese gentleman presented with complains of dyspnoea and palpitations. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole, intravenous hydrocortisone and antibiotics. About 12 hours after admission, he developed a cardiorespiratory arrest. All three patients developed cardiorespiratory arrest soon after the administration of propranolol orally. We conclude that in selective patients who have low output cardiac failure in association with severe thyrotoxicosis, it maybe advisable to avoid use of a beta blocker. A safer alternative is the use of ultra short-acting beta-blockers, such as intravenous esmolol, with extreme caution.

References

Correspondence

R. Dalan

Department of Endocrinology

Tan Tock Seng Hospital

11 Jalan Tan Tock Seng

308433 Singapore

Phone: +65/6357/78 81

Fax: +65/6357/75 88

Email: [email protected]