SHM Converge Scientific Abstract ePoster Gallery-Weathering the Storm: Utilizing Plasmapheresis in the Treatment of Thyroid Storm

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This poster describes a severe case of thyroid storm in a 55-year-old woman with untreated hyperthyroidism and alcohol use disorder. She initially presented with abdominal pain, atrial fibrillation with rapid ventricular response, and hypotension requiring vasopressors and ICU care. Laboratory testing showed suppressed TSH, elevated free T4, lactic acidosis, acute kidney injury, and transaminitis. Her condition progressed to multi-organ dysfunction and stress cardiomyopathy with an ejection fraction of 20%.<br /><br />Standard medical therapy was started, including methimazole, beta-blockade, hydrocortisone, potassium iodide, and cholestyramine. Methimazole had to be stopped because of worsening transaminitis. By hospital day 4, she had not improved, so plasmapheresis was initiated as rescue therapy. After two sessions, her free T4 fell rapidly from 3.01 to normal range, and her clinical status began to improve, including mental status and cardiac function. Methimazole was later restarted once liver enzymes improved, and propranolol was added. She was eventually stabilized, transferred out of the ICU, and underwent total thyroidectomy for definitive treatment. Postoperative calcium and PTH were normal, and her ejection fraction improved to 38%. She was discharged on levothyroxine with close endocrine, cardiology, and surgical follow-up.<br /><br />The case highlights plasmapheresis as an important bridge therapy in refractory thyroid storm or when standard treatment is limited by contraindications, such as hepatotoxicity from methimazole.

Asset Subtitle

Caroline Horne

Meta Tag

Author List Caroline Horne, Maryam Zoabi, Victoria Rollins

Category Clinical Vignettes

Concept Thyroid Storm

Concept Total Plasma Exchange

Concept Multiorgan Dysfunction

Concept Hemodynamic Instability

Concept Beta Blockers

Distinguished Non-Finalist

Presenter Organization Atrium Health Carolinas Medical Center

Presenting Author Caroline Horne

Track Adult

Keywords

thyroid storm

hyperthyroidism

plasmapheresis

methimazole

atrial fibrillation

stress cardiomyopathy

multi-organ dysfunction

thyroidectomy

hepatotoxicity

intensive care unit

Thyroid Storm

Total Plasma Exchange

Multiorgan Dysfunction

Hemodynamic Instability

Beta Blockers