Introduction: The coexistence of thyroid storm and Guillain–Barré syndrome (GBS) is rare, with few reported cases. A shared autoimmune mechanism has been suggested, although the exact pathophysiology remains unclear. In severe thyrotoxicosis, new neurological symptoms may be overlooked or attributed to metabolic causes, delaying diagnosis and posing a diagnostic and therapeutic challenge. We report a case of a 43-year-old female with Graves’ disease complicated by thyroid storm and Acute Motor Axonal Neuropathy (AMAN), a variant of GBS, highlighting the importance of early recognition and multidisciplinary management. Case: A 43-year-old female with no prior medical illness presented with fever, generalized weakness, fine tremors, and 10 kg weight loss over 5 months. On arrival, she was lethargic, febrile (40.2°C), and tachycardic (148 bpm), consistent with thyroid storm by Burch–Wartofsky criteria. She denied preceding diarrheal illness or upper respiratory tract symptoms. The thyroid function test showed markedly elevated free thyroxine 4 (>64.35 pmol/L) and suppressed thyroid-stimulating hormone (TSH) (<0.008 mIU/L). Subsequent testing revealed elevated TSH receptor antibodies (>40 IU/L), confirming Graves’ disease. Her course was complicated by anaphylactic shock with transient cardiac arrest, followed by acute kidney injury and respiratory failure requiring intensive care unit admission and mechanical ventilation. Following extubation, symmetrical limb weakness with generalized areflexia and bilateral foot drop was observed. Nerve conduction studies demonstrated a symmetrical axonal motor-predominant polyneuropathy consistent with AMAN. She received five sessions of plasma exchange and showed marked neurological improvement, while thyroid and renal function normalized at discharge. Conclusion This case highlights a rare and potentially life-threatening association of thyroid storm and AMAN. Severe thyrotoxicosis can precipitate atypical autoimmune complications, underscoring the need for vigilance. Clinicians should consider neurological evaluation in patients with severe thyrotoxicosis presenting with newonset motor weakness.
Thyrotoxicosis