{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:40:08Z","timestamp":1752471608106,"version":"3.41.2"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Thyroid storm is a life-threatening endocrine emergency characterized by an acute exacerbation of thyrotoxicosis, often triggered by stressors such as surgery or infection, with a mortality rate of 8%\u201325%. Although the risk is well-documented in thyroid surgeries, perioperative thyroid storm following non-thyroid procedures is exceedingly rare, posing diagnostic and therapeutic challenges. This case report and literature review aim to highlight the clinical features and management strategies for perioperative thyroid storm in non-thyroid surgical patients through a case analysis and literature review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 53-year-old Chinese male with a 20-year history of poorly controlled hyperthyroidism (irregular medication adherence) underwent closed reduction and intramedullary nailing for a right femoral fracture. Preoperative evaluation revealed mildly elevated free triiodothyronine (FT3: 6.87\u2005pmol\/L) and profoundly suppressed thyroid-stimulating hormone (TSH: &amp;lt;0.01\u2005mIU\/L). Antithyroid medication was omitted on the day of surgery. Following surgery and transfer to the recovery room, the patient demonstrated delayed emergence from anesthesia, with a Burch-Wartofsky score of 45 and persistent tachycardia (heart rate 144\u2005bpm), meeting Grade 1 thyroid storm criteria per Japan Thyroid Association guidelines, indicating a definitive thyroid storm. After about one hour, the patient was diagnosed with thyroid crisis. Intravenous hydrocortisone (100\u2005mg) and continuous esmolol infusion were promptly initiated, leading to gradual heart rate stabilization at 120\u2005bpm. Approximately 20\u2005minutes later, the patient regained full consciousness and met criteria for discharge from the recovery room. The patient was discharged on postoperative day 10 without complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This case underscores that non-thyroid surgery can precipitate thyroid storm in hyperthyroid patients, even with atypical presentations (e.g., absence of hyperpyrexia). Early recognition relies on vigilance toward tachycardia and altered mental status. Perioperative management should emphasize: (1) rigorous preoperative optimization of thyroid function to achieve euthyroidism; (2) vigilant postoperative monitoring for early signs of thyroid storm; and 3) prompt diagnosis using the Burch-Wartofsky scale and guideline-based criteria, followed by combined therapy with beta-blockers, corticosteroids, and antithyroid drugs. This case uniquely demonstrates that non-thyroid surgery can precipitate thyroid storm without classic hyperthermia, highlighting the need for standardized monitoring protocols in hyperthyroid surgical patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1633314","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:25:45Z","timestamp":1752470745000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Thyroid storm during the recovery phase after non-thyroid surgery in a hyperthyroid patient: a case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Jiyu","family":"Zeng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1089\/thy.2011.0334","article-title":"Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys","volume":"22","author":"Akamizu","year":"2012","journal-title":"Thyroid"},{"key":"B2","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1089\/thy.2018.0275","article-title":"National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004\u20132013","volume":"29","author":"Galindo","year":"2019","journal-title":"Thyroid"},{"key":"B3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/S0889-8529(18)30165-8","article-title":"Life-threatening thyrotoxicosis: thyroid storm","volume":"22","author":"Burch","year":"1993","journal-title":"Endocrinol Metab Clin N Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/j.bja.2021.06.043","article-title":"Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review","volume":"127","author":"de Mul","year":"2021","journal-title":"Br J Anaesth"},{"key":"B5","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/CCM.0000000000004078","article-title":"Thyroid storm in the ICU: a retrospective multicenter study","volume":"48","author":"Bourcier","year":"2020","journal-title":"Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e37396","DOI":"10.1097\/MD.0000000000037396","article-title":"Diagnostic criteria and scoring systems for thyroid storm: an evaluation of their utility - comparative review","volume":"103","author":"Elendu","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12245-023-00490-4","article-title":"Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report","volume":"16","author":"Ohya","year":"2023","journal-title":"Int J Emerg Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e231090","DOI":"10.1136\/bcr-2019-231090","article-title":"Atypical presentation of thyroid storm: a diagnostic dilemma","volume":"12","author":"Banerjee","year":"2019","journal-title":"BMJ Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1507\/endocrj.EJ16-0336","article-title":"2016 guidelines for the management of thyroid storm from the Japan thyroid association and Japan endocrine society (first edition)","volume":"63","author":"Satoh","year":"2016","journal-title":"Endocr J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.jclinane.2015.03.023","article-title":"Delayed emergence after anesthesia","volume":"27","author":"Tzabazis","year":"2015","journal-title":"J Clin Anesth"},{"key":"B11","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1007\/s00540-013-1598-4","article-title":"A case of delayed emergence from anesthesia caused by postoperative brain edema associated with unexpected cerebral venous sinus thrombosis","volume":"27","author":"Kozasa","year":"2013","journal-title":"J Anesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12871-023-02056-6","article-title":"Risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery","volume":"23","author":"Wang","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1007\/s11605-011-1640-5","article-title":"Depression is associated with prolonged and complicated recovery following colorectal surgery","volume":"15","author":"Balentine","year":"2011","journal-title":"J Gastrointest Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1089\/thy.2016.0229","article-title":"2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis","volume":"26","author":"Ross","year":"2016","journal-title":"Thyroid"},{"key":"B15","doi-asserted-by":"publisher","first-page":"104487","DOI":"10.1016\/j.amsu.2022.104487","article-title":"Perioperative management of the thyrotoxic patients: a systematic review","volume":"81","author":"Terefe","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1186\/s12871-024-02801-5","article-title":"Thyroid storm in a patient with unknown hyperthyroidism during nonthyroidal surgery-a case report and literature review","volume":"24","author":"Shao","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"450","DOI":"10.3390\/medicina58030450","article-title":"Thyroid storm superimposed on gestational hypertension: a case report and review of literature","volume":"58","author":"Chen","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"104600","DOI":"10.1016\/j.amsu.2022.104600","article-title":"Ruptured appendicitis with undiagnosed Graves\u2019 disease: contrast-induced impending thyroid storm","volume":"82","author":"Sungworawongpana","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e28928","DOI":"10.1097\/MD.0000000000028928","article-title":"Postoperative thyroid crisis in an 11-year old male with McCune-albright syndrome and atypical triiodothyronine hyperthyroidism: a case report","volume":"101","author":"Hu","year":"2022","journal-title":"Medicine (Baltimore)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/iju5.12341","article-title":"Postoperative thyroid storm after radical nephrectomy for renal cell carcinoma with inferior vena cava tumor thrombus","volume":"4","author":"Iwahara","year":"2021","journal-title":"IJU case Reports"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e01495","DOI":"10.1213\/XAA.0000000000001495","article-title":"Postoperative thyroid storm after evacuation of a complete hydatidiform mole: a case report","volume":"15","author":"Hodgson","year":"2021","journal-title":"A&A Practice"},{"key":"B22","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s13019-020-1044-2","article-title":"Thyroid storm after coronary artery bypass surgery: a case report","volume":"15","author":"Lee","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1111\/jocs.15245","article-title":"Thyroid storm after mitral valve repair in a patient with becker muscular dystrophy","volume":"36","author":"Yamazaki","year":"2021","journal-title":"J Card Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"924","DOI":"10.11406\/rinketsu.60.924","article-title":"Thyroid storm and exacerbation of autoimmune hemolytic anemia following childbirth","volume":"60","author":"Sugisaki","year":"2019","journal-title":"Jpn J Clin Hematol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e3239","DOI":"10.7759\/cureus.3239","article-title":"Acute thyroid storm following thymectomy: a surprising result of undiagnosed Graves\u2019 disease","volume":"10","author":"Shoja","year":"2018","journal-title":"Cureus"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2338.e5","DOI":"10.1016\/j.ajem.2018.09.006","article-title":"Thyroid storm following rapid sequence intubation","volume":"36","author":"Pride","year":"2018","journal-title":"Am J Emerg Med"},{"key":"B27","first-page":"843","article-title":"Thyroid storm precipitated by intracranial surgery in a woman with No history of thyroid disease","volume":"65","author":"Fuji","year":"2016","journal-title":"Masui Jpn J Anesthesiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e0300","DOI":"10.1097\/MD.0000000000010300","article-title":"Use of low-dose neostigmine intravenously in the treatment of thyroid storm-induced severe tachycardia in patient during huge pelvic mass resection: a case report and review of literature","volume":"97","author":"Zhang","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/0974-8237.135230","article-title":"Thyroid storm following anterior cervical spine surgery for Koch\u2019s spine","volume":"5","author":"Huzurbazar","year":"2014","journal-title":"J Craniovertebr Junction Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.1016\/j.jtcvs.2010.06.034","article-title":"Thyroid storm after coronary artery bypass grafting","volume":"140","author":"Bish","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B31","first-page":"1541","article-title":"Case of thyroid crisis with persistent tachycardia diagnosed postoperatively","volume":"58","author":"Tamada","year":"2009","journal-title":"Masui Jpn J Anesthesiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"732","DOI":"10.4158\/EP.14.6.732","article-title":"Development of thyroid storm after surgical resection of a thyrotropin-secreting pituitary adenoma","volume":"14","author":"Page","year":"2008","journal-title":"Endocr Pract"},{"key":"B33","first-page":"418","article-title":"Perioperative thyroid storm in a patient with undiscovered hyperthyroidism","volume":"54","author":"Nakamura","year":"2005","journal-title":"Masui Jpn J Anesthesiol"},{"key":"B34","volume-title":"The Diagnosis and Management of a Perioperative Thyrotoxic Crisis","author":"Le Roux","year":"2023"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1633314\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:25:46Z","timestamp":1752470746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1633314\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2025.1633314"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1633314","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,14]]},"article-number":"1633314"}}