Thyroid storm with simultaneous hypercalcemic crisis – life-threatening complications of unconventional therapy of Graves’ disease

Abstract

Thyroid storm is a life-threatening endocrine disorder most often associated with uncontrolled or undiagnosed Graves’ disease (GD). As thyroid hormones are involved in bone metabolism, hyperthyroidism may lead to hypercalcemia, usually mild to moderate. However, several cases of hypercalcemic crisis during thyrotoxicosis have been described.

We present a case of severe thyroid storm with simultaneous hypercalcemic crisis resulting from excessive intake of 5% Lugol’s iodine solution (5% iodine, 10% potassium iodide, 85% water; 10 drops/day) and vitamin D₃ (10000 IU/day) during two months of unconventional treatment in a 78-year-old female with a history of hyperthyroidism in the course of GD. Herbalist/healer prescribed supplements before admission to the hospital. At the clinic, we started therapy with antithyroid drugs (ATDs), inorganic iodide and corticosteroids but without positive effect. The patient’s condition kept deteriorating with loss of consciousness. Moreover, the patient suffered from severe complications, including Takotsubo cardiomyopathy and sepsis, requiring intensive care unit. Finally, therapeutic plasmapheresis (TPE) (4 procedures) was required to reduce thyroid hormone levels successfully. Total thyroidectomy was performed, resulting in postoperative hypothyroidism and transient hypoparathyroidism. Treatment with corticosteroids led to transient secondary adrenal insufficiency. Following 2-month of hospitalization, the patient was discharged in stable condition.

Hypercalcemic crisis is a rare but severe complication of thyrotoxicosis; therefore, it should be considered in diagnostic and therapeutic process. Unconventional therapies conducted by “healers” may lead to life-threatening complications. TPE should be considered in patients with thyrotoxicosis resistant to the standard therapy with ATDs, corticosteroids and beta-blockers.