Thyroid Storm in the Shadows of Multiple Endocrine Neoplasia (Men) 2A: A Case of Overlapping Endocrine Emergencies

Abstract

Thyroid storm is observed in patients with untreated Graves' disease, typically triggered by stressors such as acute illness or recent surgery. This case presents a female with acute metabolic encephalopathy initially attributed to drug overdose and septic shock, later diagnosed with thyroid storm. Despite clinical stabilisation, the patient developed resistant hypertension and elevated metanephrine levels, raising suspicion for phaeochromocytoma and potential multiple endocrine neoplasia (MEN) 2A. This case highlights the importance of considering syndromic and autoimmune associations in complex endocrine presentations. Learning points: Thyroid storm should be considered when there is a rising temperature and increasing agitation despite appropriate treatment.If hypertension persists after the fever of thyroid storm was managed with propylthiouracil and iodine an additional diagnosis, such as phaeochromocytoma, should be considered.We found no published reports on MEDLINE linking Graves' disease or thyroid storm with MEN 2A to help guide our management.