Thyroid storm is a rare and potentially fatal disease characterized by severe clinical manifestations of thyrotoxicosis. The most common cause of hyperthyroidism is Graves’s disease (GD) and infections are the most important precipitating factor. A woman of 33 years with history of hyperthyroidism, hypertension and morbid obesity. She was treated with propylthiouracil for one year, and then suspended controls and treatment 2 years ago. Consult for 2 weeks characterized by dyspnea, cough and expectoration, plus an episode of generalized tonic-clonic seizure. In postictal state, persists with dyspnea and chest pain, which is brought to the emergency room. It is hypotensive, with fever and tachycardia, SatO2 60% on room air. It is intubated and connected to invasive mechanical ventilation. It evolves with monomorphic ventricular tachycardia, requiring cardioversion twice, recovering sinus rhythm. Imaging studies reported bilateral lung disease. CT scan brain and lumbar punture are normal. As is treated as septic shock lung focus.

Among its tests:

TSH 0.01 mIU/L, T4 T 23.9 ug/dL, T4L 4.77 ng/dL, T3 5.38 ng/ml, with Wartofsky Score: 90. It is managed as TS, treatment is initiated with methimazole, Propranolol, Hydrocortisone.

Thyroid ultrasound shows:

Goiter with cold nodules. In addition has positive TRAb. She recovers both of system cardiovascular and their respiratory infection. The patient is prepared with amiodarone and lugol for total thyroidectomy. Concordant biopsy with GD.