Chest Pain as the Initial Manifestation of Thyroid Storm Secondary to Graves’ Disease: a Case Report

Abstract

We present the case of a 34-year-old female patient who presented to the emergency department with sharp chest pain accompanied by palpitations and diaphoresis; the pain did not radiate and was unrelated to physical exertion. She reported no significant medical history. Upon admission, fever and sinus tachycardia were documented, with no electrocardiographic signs of ischemia or strain, and with negative troponins, suppressed thyroid-stimulating hormone (TSH) levels, and elevated free thyroxine (fT4). Based on the Burch-Wartofsky criteria, a diagnosis of thyroid storm was established as the initial presentation of hyperthyroidism. During follow-up, Graves’ disease was confirmed by the presence of TSH receptor antibodies. Treatment with methimazole, Lugol’s solution, and propranolol was initiated, resulting in subsequent heart rate control and symptom resolution. No additional precipitating factors were identified during hospitalization. Outpatient management and follow-up by endocrinology and family medicine were prescribed, achieving sustained clinical and biochemical control for over six months. The aim of this report is to highlight thyroid storm as a rare and potentially life-threatening condition that may present with nonspecific cardiovascular and systemic manifestations, requiring a high index of suspicion for timely diagnosis and treatment.