Impending thyroid storm in a case of Down syndrome with burr hole surgery: A case report

Introduction: An accidental injury requiring surgery in a patient with Down syndrome (DS) and hyperthyroidism is an uncommon case, in which thyroid hormone control plays a crucial role in successful surgery. Case presentation: An Indonesian woman, 33 years old, suffered an accidental brain injury and gradually lost consciousness. She was born with DS and had no prior medical consultation. At the emergency room, she was diagnosed with hyperthyroidism and an acute subdural hematoma. According to the Burch-Wartofsky (BW) score, the examination revealed an impending thyroid storm (40 points). Management of hyperthyroidism aims to avoid the thyroid storm before, during, and after double burr hole drainage, which is treated with glucocorticoid and antithyroid drugs. She was followed up for 6 months after surgery and had considerable improvement. Conclusion: Management of hyperthyroidism have a crucial role in DS patient with burr hole drainage to improve surgical outcomes, control of cardiac output, and minimize thyroid storm.