Thyroid storm, a life‐threatening endocrine emergency, is exceptionally rare in patients with hypothyroidism. This case highlights the unique challenge of diagnosing and managing thyroid storm in the context of concurrent Graves′ disease and Hashimoto′s thyroiditis, a paradoxical coexistence of autoimmune thyroid disorders. We present a 70‐year‐old South Asian female with hypothyroidism on levothyroxine, who developed thyroid storm confirmed by clinical criteria (Burch–Wartofsky score> 45) and laboratory findings, including elevated T3/T4 and suppressed TSH. Autoimmune markers revealed the coexistence of Graves′ disease and Hashimoto′s thyroiditis. Her clinical presentation included atrial fibrillation, pulmonary congestion, and acute heart failure, with further workup revealing Takotsubo cardiomyopathy, complicating the clinical course. Management included antithyroid therapy, corticosteroids, iodine, and cholestyramine, resulting in clinical stabilization, normalization of cardiac function, and resolution of thyroid storm. This case underscores the need to recognize autoimmune thyroid disorders as potential causes of paradoxical thyroid dysfunction in hypothyroid patients. Comprehensive evaluation and tailored management are critical to achieving favorable outcomes in such complex scenarios.
Villegas et al. (Thu,) studied this question.