International Journal of Thyroidology  2017;10(1):56-60

doi:10.11106/ijt.2017.10.1.56

A Case of Acute Cerebral Infarction and Thyroid Storm Associated with Moyamoya Disease.

Seol A JANG 1 ; Young Ha BAEK ; Tae Sun PARK ; Kyung Ae LEE

Affiliations

+expand

Keywords

Moyamoya disease; Graves' disease; Thyroid storm

Country

Republic of Korea

Language

English

MeSH

Abstract

Coexistence of moyamoya disease and Graves' disease is rare. A 41-year-old woman presented with symptoms of left-sided hemiparesis and dysarthria. Magnetic resonance imaging and angiography revealed acute infarction of the right thalamus and occipital lobe with complete obstruction of the distal internal carotid arteries and obstruction of the right P2. Free thyroxine, thyroid-stimulating hormone (TSH), and TSH receptor antibody levels were 79.33 pmol/L, 0.007 uIU/mL, and 151.5 u/L, respectively. She received antiplatelet therapy and standard antithyroid drug dose. After admission, seizure and unexplained fever occurred. The thyroid storm score (Burch and Wartofsky scale) was 90 points. After intensive treatment, mental status and thyrotoxicosis-related symptoms ameliorated and vital signs stabilized. We describe a case of thyroid storm following cerebrovascular ischemic events in a Korean woman with moyamoya disease and Graves' disease. Thyroid storm combined with cerebrovascular events can lead to severe morbidity and mortality. Prompt recognition and strict management are crucial.