Thyroid Storm Complicated by Multisystem Organ Failure Requiring Plasmapheresis to Bridge to Thyroidectomy: A Case Report and Literature Review

Abstract

Thyroid storm is a rare life-threatening medical emergency. It is associated with high mortality (10 to 30%) [1]. It is characterized by severe thyrotoxicosis and systemic hemodynamic decompensation. There are multiple risk factors but usually patients with Graves’ disease are at a greater risk [1]. Patients can present with diverse signs and symptoms and varying degrees of organ decompensation. Treatment should be initiated promptly by targeting all steps of thyroid hormone synthesis, release and action. Patients who are not responding appropriately to medical therapy should be treated with therapeutic plasma exchange and later thyroidectomy once the patient is stabilized [2]. Here, we report a case of thyroid storm secondary to noncompliance with medication for Graves’ disease which was managed appropriately in an intensive care unit (ICU) setting initially with medical therapy, then plasmapheresis and ultimately thyroidectomy.