Case Report

A 26-year-old female with no significant medical history presented with palpitations and shortness of breath. Two weeks prior, she experienced rhinorrhea and congestion.Vital signs on admission were temperature 96.6°F, heart rate 252 beats per minute, blood pressure 127/74 mmHg, respiratory rate 24 breaths per minute, oxygen saturation 98% on room air. On exam, the patient was tachycardic and had a large, homogenous thyroid without any palpable nodules. The rest of her physical exam was unremarkable.

Laboratory data revealed total bilirubin 4.4 mg/dL, aspartate aminotransferase 245 units/L, alanine aminotransferase 263 units/L, thyroid stimulating hormone (TSH) 0.02 miU/L, free thyroxine (T4) 5.5 ng/dL, and free triiodothyronine (T3) 21.4 pg/ mL. Electrocardiogram revealed supraventricular tachycardia. Computed tomography angiogram of the chest revealed a grossly enlarged thyroid, a left lower lobe infiltrate, and no evidence of pulmonary embolism. The patient was cardioverted to sinus rhythm and was started on a continuous infusion of diltiazem. She then became hypotensive and tachypneic and was subsequently intubated. Thionamide medications, including methimazole and propylthiouracil, for the patient's hyperthyroid state were initially held due to acute liver failure.