Cardiovascular collapse associated with beta blockade in thyroid storm.

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.

• Authors: R Dalan, Melvin K Leow, Melvin C Leow, M Leow
• Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association (Exp Clin Endocrinol Diabetes) Vol. 115 Issue 6 Pg. 392-6 (Jun 2007) ISSN: 0947-7349 [Print] Germany
• PMID: 17701886 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Anti-Inflammatory Agents
• Antithyroid Agents
• Carbimazole
• Propranolol
• Hydrocortisone

Topics

• Administration, Oral
• Adrenergic beta-Antagonists (administration & dosage, adverse effects)
• Adult
• Aged
• Anti-Inflammatory Agents (administration & dosage)
• Antithyroid Agents (administration & dosage)
• Asian People
• Carbimazole (administration & dosage)
• Female
• Heart Arrest (chemically induced)
• Humans
• Hydrocortisone (administration & dosage)
• Injections, Intravenous
• Male
• Middle Aged
• Propranolol (administration & dosage, adverse effects)
• Thyroid Crisis (complications, drug therapy)