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Final Program


Final Program

Stroke

310 - Cascading Thyrotoxicosis - Ischemic Stroke In a Healthy 38 Year-Old Patient: A Case Report.

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: 38 year-old female who presented with a large, left middle cerebral artery stroke secondary to thyrotoxicosis.

Case Description: The patient presented to the emergency department with acute right hemiplegia and left-sized gaze preference. The NIHSS score on arrival was 22. The patient did not have any relevant past medical history. CTA head and neck showed occlusion of the bilateral anterior cerebral arteries.  Tenecteplase was promptly administered and the patient was intubated for airway protection. She was later taken to the interventional radiology suite for mechanical thrombectomy. During her admission, cardiac monitoring illustrated atrial fibrillation with rapid ventricular rate. IV amiodarone was administered and further workup was ordered including thyroid function studies. Workup revealed TSH 0.01, free T4 7.77, free T3 23.7, which was consistent with severe thyrotoxicosis and subsequent atrial fibrillation. For this reason, methimazole was started. The patient was extubated and medically stabilized before being transferred to the acute rehabilitation unit.

Discussions:

This case highlights that in an otherwise young, healthy patient, recognition and treatment of thyroid dysfunction is paramount in preventing cascading effects that lead to cerebrovascular events. While this case highlighted thyrotoxicosis triggering atrial fibrillation, current literature mentions that it may also cause hypercoagulability, vasculopathy, and immune-mediated vascular injury leading to stroke. Moreover, previous studies have described low free T3 values (less than 2.00 pg/mL) as independently associated with worse Modified Rankin scores at 3 months after stroke onset. Early detection of thyroid dysfunction and stabilization by primary medical and rehabilitation teams is key in preventing recurrent strokes.

Conclusions: Timely identification and treatment of hyperthyroidism is essential in the management and prevention of cerebrovascular disease. Failure to discover hyperthyroidism can lead to poor neurological outcomes, even in younger populations without traditional stroke risk factors.