Serotonin syndrome unmasking thyrotoxicosis.
Geoffrey Peter Ronan, Nicola Ronan, Siobhan Mcgettigan, Gemma Browne
BMJ case reports March 7, 2019 DOI: 10.1136/bcr-2018-228404 via PubMed
Summary
A 26-year-old cachectic man with chronic drug abuse presented with altered mental status, agitation, tremors, hyperthermia, diaphoresis, and dilated pupils after acute ingestion of MDMA. His condition deteriorated, requiring sedation and intensive care. Serotonin syndrome was diagnosed using Hunter criteria, and supportive care managed a brief delirium. After recovery, blood work revealed concurrent thyrotoxicosis, which may have contributed. He was treated for thyroid disease and referred for specialist follow-up.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 26-year-old cachectic man with chronic drug abuse and acute MDMA ingestion |
| Keywords | Delirium Endocrine system Metabolic disorders Thyroid disease Toxicology |
| Citations | 4 |
| Key finding | Serotonin syndrome from MDMA ingestion can co-occur with undiagnosed thyrotoxicosis, which may exacerbate the presentation. |
Abstract
A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.