SHM Converge Scientific Abstract ePoster Gallery-Thyroid Storm Refractory to Medical Management

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This case describes a woman in her 50s with no major past medical history who presented with 1–2 weeks of worsening leg swelling, shortness of breath, and a long-term 40-lb unintentional weight loss. On arrival, she was tachycardic to 190 bpm and had atrial fibrillation with rapid ventricular response. Examination showed proptosis, lid lag, smooth nontender thyromegaly, and marked edema. Labs confirmed severe hyperthyroidism, and echocardiography suggested tachycardia-induced cardiomyopathy with an ejection fraction of 40–50%.<br /><br />She was admitted to the ICU for suspected thyroid storm and treated aggressively with propranolol, methimazole, high-dose hydrocortisone, iodine, and later cholestyramine. Thyroid ultrasound demonstrated a diffusely hypervascular gland, and autoimmune testing supported autoimmune thyroiditis. Despite temporary improvement in thyroid hormone levels, she remained clinically hyperthyroid and had recurrent disease activity, requiring escalation of therapy. Ultimately, because medical management was insufficient, she underwent total thyroidectomy.<br /><br />The case emphasizes that thyroid storm is a life-threatening emergency requiring rapid recognition and aggressive treatment. It also highlights that some patients are refractory to standard medical therapy and may need definitive treatment such as thyroidectomy or radioactive iodine ablation. The Burch-Wartofsky Point Scale is noted as a useful diagnostic tool, with scores above 45 strongly suggesting thyroid storm. Overall, this report underscores the importance of timely diagnosis, close monitoring, and flexibility in management to reduce morbidity and mortality.

Asset Subtitle

Rashelle Ripa

Meta Tag

Author List Debra Margulies, Jennifer Su, Mahija Cheekati, Rashelle Ripa

Category Clinical Vignettes

Concept Thyroid Storm

Concept Thyrotoxicosis

Concept Beta-Blockade

Concept Antithyroid Therapy

Concept Atrial Fibrillation

Distinguished Non-Finalist

Presenter Organization Morristown Medical Center

Presenting Author Rashelle Ripa

Track Adult

Keywords

thyroid storm

hyperthyroidism

atrial fibrillation

tachycardia-induced cardiomyopathy

proptosis

thyroidectomy

Burch-Wartofsky Point Scale

Graves disease

ICU management

weight loss

Thyroid Storm

Thyrotoxicosis

Beta-Blockade

Antithyroid Therapy

Atrial Fibrillation