PT  - JOURNAL ARTICLE
AU  - Geoffrey Peter Ronan
AU  - Nicola Ronan
AU  - Siobhan McGettigan
AU  - Gemma Browne
TI  - Serotonin syndrome unmasking thyrotoxicosis
AID  - 10.1136/bcr-2018-228404
DP  - 2019 Mar 01
TA  - BMJ Case Reports
PG  - e228404
VI  - 12
IP  - 3
4099  - http://casereports.bmj.com/content/12/3/e228404.short
4100  - http://casereports.bmj.com/content/12/3/e228404.full
SO  - BMJ Case Reports2019 Mar 01; 12
AB  - 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.