Scientific Poster Session II - Case Reports

Abstract

Thyroid storm (TS), an urgent complication resulting from excessive thyroid hormone activity, carries a high risk of mortality. Single-pass albumin dialysis (SPAD) has shown promise in managing severe thyrotoxicosis. SPAD employs albumin as a dialysis solution to eliminate excess thyroid hormones from the bloodstream.

Limited literature exists on SPAD's application in TS. We present a case report of an elderly male with multiple co-morbidities experiencing TS and the successful utilization of SPAD during his hospitalization.

Case:

A 75-year-old male with an extensive past medical history including coronary artery disease, ischemic cardiomyopathy with reduced ejection fraction (EF 20%), atrial fibrillation recently initiated amiodarone, presented to the emergency department with concerns for decompensated heart failure.

Labs revealed suppressed thyroid-stimulating hormone (TSH) and elevated free T4 hormone levels and a diagnosis of amiodarone-induced thyroiditis was made. Amiodarone was discontinued, and treatment with oral methimazole, lugol’s iodine, hydrocortisone, and propranolol initiated.

Despite maximal medical management, the patient's condition deteriorated to refractory TS. A decision was made to initiate SPAD to achieve an euthyroid state as a bridge to decision or thyroidectomy. SPAD was performed using an existing continuous renal replacement therapy (CRRT) circuit and dialysate containing 3% albumin. The patient underwent multiple SPAD sessions and showed consecutive improvement in thyroid function tests but with a lag in clinical improvement. Despite achieving an euthyroid state, the patient suffered a cardiac arrest due to ventricular tachycardia.

The patient's condition continued to deteriorate and ultimately, given progressive multi-organ failure resulting from shock, the patient passed away.

Discussion: Although an unfortunate patient outcome in this case, the improvement in thyroid function due to SPAD shows promise for treatment of TS and should be further studied to find optimal therapy.

Conclusion: Amiodarone induced TS can be successfully treated with SPAD. Knowledge gained in this experience can guide future treatment in refractory TS.

Presenting Author

Authors