A case of subarachnoid hemorrhage complicated by thyroid storm at the initial visit

Abstract

A 49-year-old female was transferred to our hospital with a sudden onset of confusion after headache. The patient was in a severely confused state, and the physical examination revealed tachycardia, tachypnea, fever, abnormal sweating, exophthalmos, and thyroid enlargement. Computed tomography (CT) of her head showed subarachnoid hemorrhage, and laboratory data revealed a high serum level of FT3 and FT4 and a low serum level of thyroid-stimulating hormone. We diagnosed the patient as having a subarachnoid hemorrhage complicated by thyroid storm. We made it a priority to control the thyroid storm and treat the subarachnoid hemorrhage conservatively at first. After the normalization of the thyroid hormone level, we performed surgical clipping. The patient had a favorable outcome. Thyroid storm is a life-threatening disease that requires emergency treatment. The symptoms of thyroid storm resemble those of subarachnoid hemorrhage; thus, the diagnosis of thyroid storm is difficult in the case of coexisting subarachnoid hemorrhage. Emergency surgery for subarachnoid hemorrhage with an oversight of thyroid storm can cause progressive exacerbation of the general condition, with the progression of thyroid storm. In the present case, we could reach a diagnosis of thyroid storm by suspecting Basedow disease based on vital signs and physical examinations. Priority treatment for thyroid storm and an elective surgery for subarachnoid hemorrhage led to a favorable outcome.