SHM Converge Scientific Abstract ePoster Gallery-Canceled Amidst the Storm: Recognizing Thyroid Storm Before Undergoing Anesthesia

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A 67-year-old man with Graves’ disease, atrial fibrillation, and chronic NSAID use presented with 10 days of melena, dizziness, fatigue, and new confusion. He was found to have anemia and suspected upper gastrointestinal bleeding (UGIB), and an upper endoscopy was scheduled. However, thyroid studies obtained shortly before the procedure showed markedly elevated free T4 and suppressed TSH, and his Burch-Wartofsky score of 45 was highly suggestive of thyroid storm.<br /><br />Because thyroid storm significantly increases peri-anesthetic risk, the planned endoscopy was canceled and endocrinology was consulted. The patient was started on methimazole, propranolol, and hydrocortisone. His mental status returned to baseline within two days, and his tachycardia and thyroid hormone levels gradually improved. He required 5 units of packed red blood cells during the first three hospital days due to ongoing melena, but CT angiography showed no active bleeding.<br /><br />Once he was clinically more stable and thyroid function improved, endoscopy was safely performed on hospital day 5. It revealed two 8-mm nonbleeding prepyloric antral ulcers. He was discharged on pantoprazole, sucralfate, methimazole, and propranolol.<br /><br />This case highlights the difficulty of managing two acute conditions that worsen each other: thyroid storm and UGIB requiring anesthesia. It emphasizes the importance of recognizing thyroid storm before procedural sedation or general anesthesia, since proceeding too early may increase the risk of end-organ ischemia and poor outcomes.

Asset Subtitle

Aqeel Khanani

Meta Tag

Author List Alec Werthman, Alexis Ferguson, Aqeel Khanani, Sohaib Ahmed

Category Clinical Vignettes

Concept Thyroid Storm

Concept Hyperthyroidism

Concept Thyrotoxicosis

Concept Antithyroid Medication

Concept Beta Blocker

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health Medical Center

Presenting Author Aqeel Khanani

Track Adult

Keywords

thyroid storm

Graves disease

upper gastrointestinal bleeding

melena

anemia

endoscopy

anesthesia risk

atrial fibrillation

methimazole

propranolol

Thyroid Storm

Hyperthyroidism

Thyrotoxicosis

Antithyroid Medication

Beta Blocker