SHM Converge Scientific Abstract ePoster Gallery-The Calm Before the Storm

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This case report describes a 24-year-old woman who developed thyroid storm triggered by group A streptococcal (GAS) pharyngitis. She presented with two days of fever, sore throat, chest tightness, and marked tachycardia, and was found to be in supraventricular tachycardia with a heart rate of 180 bpm. Exam showed severe purulent pharyngitis and a non-tender goiter.<br /><br />Initial treatment in the emergency setting included adenosine, dexamethasone, and antibiotics. Because her Burch-Wartofsky score was 55, she was diagnosed with thyrotoxicosis/thyroid storm. Laboratory workup showed undetectably low TSH and very high free T4 (8 ng/dL), while thyroid antibodies and total T3 were normal. She also had mildly elevated liver enzymes and an elevated BNP, but echocardiography showed no cardiomyopathy or valvular disease. A rapid antigen test confirmed GAS infection.<br /><br />She was treated promptly with propranolol, propylthiouracil, potassium iodide, hydrocortisone, and amoxicillin/clavulanate. Her symptoms and biochemical markers improved, and propylthiouracil was later switched to methimazole. She was discharged on methimazole, propranolol, and antibiotics, and at follow-up she was asymptomatic, allowing discontinuation of methimazole and propranolol.<br /><br />The key message is that thyroid storm is a life-threatening endocrine emergency with high mortality and should be recognized early, especially when patients present with fever, tachyarrhythmia, liver dysfunction, or other signs of organ compromise. Clinicians should be aware that GAS pharyngitis can act as a trigger for thyroid storm, and rapid treatment can prevent deterioration and lead to full recovery.

Asset Subtitle

Valeria G. Hanson

Meta Tag

Author List Abu Baker Sheikh, Michaela L. Barbera, Valeria G. Hanson

Category Clinical Vignettes

Concept Thyroid Storm

Concept Burch-Wartofsky Point Scale

Concept Antithyroid Drugs

Concept Endocrine Emergency

Concept Fever

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Valeria G. Hanson

Track Adult

Keywords

thyroid storm

group A streptococcal pharyngitis

thyrotoxicosis

supraventricular tachycardia

Burch-Wartofsky score

free T4

low TSH

propylthiouracil

methimazole

endocrine emergency

Thyroid Storm

Burch-Wartofsky Point Scale

Antithyroid Drugs

Endocrine Emergency

Fever