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Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis
Vaishnavi Divya Nagarajan1, Alba Morales2, Lawtanya Pleasant2
1Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA divya.nagaraj@uky.edu.
Insights
Thyroid storm, a severe hyperthyroidism complication, rarely occurs. This case highlights plasmapheresis as a life-saving treatment for paediatric thyroid storm when standard therapies are contraindicated due to septic shock and agranulocytosis.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Hematology
Background:
- Paediatric hyperthyroidism is predominantly caused by Graves' disease.
- Thyroid storm, a rare but life-threatening complication of severe thyrotoxicosis, affects 1%-2% of hyperthyroid patients.
- Standard management involves antithyroid medications and beta-blockers.
Abstract:
Paediatric hyperthyroidism cases are mostly caused by Grave's disease. Thyroid storm is a life-threatening condition seen rarely, in severe thyrotoxicosis, occurring in about 1%-2% of patients with hyperthyroidism. Antithyroid medications and beta-blockers are typically the first-line management of thyroid storm. We report a challenging case of a 15-year-old girl who presented with thyroid storm in the setting of septic shock and methimazole-induced agranulocytosis. Since the first-line agents were contraindicated, plasmapheresis was used to control the thyroid storm and as a bridging therapy to the definitive therapy of early thyroidectomy. This is the first paediatric case report that outlines the use of plasmapheresis in the management of complicated thyrotoxicosis in a setting of septic shock.
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