Case Study: Urotensin II’s Unmasking in a Thyroid Storm
Patient: Sarah, a 35-year-old woman with Graves’ disease diagnosed two years ago. Despite antithyroid medication adherence, she presented to the emergency department with a five-day history of escalating symptoms.
Presentation: Fever, severe tachycardia (180 bpm), tremors, diaphoresis, confusion, and agitation. Physical examination revealed thyromegaly, exophthalmos, and signs of dehydration. Initial labs confirmed hyperthyroidism with elevated free T3 and T4, suppressed TSH, and leukocytosis.
Workup: Given the clinical picture, suspicion of thyroid storm arose. Burch-Wartofsky Point Score (BWPS) reached 80, further strengthening the diagnosis. Chest X-ray and ECG showed tachycardia and nonspecific ST-segment changes. Echocardiogram revealed normal left ventricular function. To delve deeper, UII levels were measured, exceeding the established reference range for hyperthyroidism, a novel finding.
Management: The primary focus was rapid antithyroid therapy with propylthiouracil and beta-blockade to control heart rate. Glucocorticoids were administered to dampen the inflammatory response, and supportive measures like hydration and electrolyte correction were initiated. Notably, intravenous UII receptor antagonist, though still under investigation, was cautiously introduced as adjunctive therapy based on the elevated UII levels and presumed contribution to cardiovascular instability.
Course: Over the next 48 hours, Sarah’s symptoms gradually improved. Her heart rate stabilized, tremors subsided, and mental clarity returned. UII levels showed a declining trend alongside normalization of thyroid hormone levels. The UII receptor antagonist was slowly weaned off with no adverse effects. Sarah remained hospitalized for further monitoring and optimization of antithyroid therapy before a successful discharge on a stable regimen.
Discussion: This case highlights the potential role of UII in thyroid storm. Sarah’s elevated UII levels, coupled with their decline alongside clinical improvement, suggest a link between this vasoconstrictor and the severity of her storm. The use of UII receptor antagonist, while experimental, provides compelling evidence for its potential as a future therapeutic option in specific cases.
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