Does Hyperthyroidism Increase Risk of Death Due to the Ingestion of Ecstasy?

: Ecstasy (3,4‐methylenedioxymethamphetamine, MDMA) is a psychoactive amphetamine derivative widely used for recreational purposes. Deaths caused by acute drug intoxication with MDMA are rare but can often involve a severe hyperthermic episode. The factors underlying the increased risk of some ecstasy users to a fatal drug reaction are not known. We present a case report of a 24‐year‐old woman who developed fatal hyperthermia with multi‐organ complications following MDMA use and was found at autopsy to have diffuse thyroid hyperplasia (Graves’ disease). An antemortem blood MDMA concentration of 0.68 mg/L was measured in a sample obtained on admission to hospital. Although a cause and effect cannot be established, as the thyroid hormone is a major regulator of thermogenesis, we suggest that hyperthyroidism predisposed the subject to ecstasy‐induced hyperthermia and that a pre‐existing defect affecting temperature status could be one factor in explaining some ecstasy intoxication deaths.