A Case Report of Thyroid Storm with Cardiovascular Collapse After Propranolol Administration

Thyroid storm is a rare, life-threatening emergency with a 3.6-17% mortality rate despite proper management. Elevated levels of circulating thyroid hormones can increase metabolic demand, leading to adverse effects on multiple organ systems, particularly critical cardiovascular complications such as cardiomyopathy, myocardial infarction, ventricular arrhythmias, or coronary vasospasm. Precipitating factors can include infection, surgery, or trauma, with infection being the most common. The potential for cardiovascular mortality is high. While beta blockers are key for treatment, they can potentially reduce necessary cardiac output, risking hemodynamic collapse. Traditionally, propranolol has been recommended. We report a rare case of an adolescent experiencing cardiac arrest after propranolol administration in thyroid storm and acute appendicitis.

A 17-year-old female with a history of Grave disease, non-adherent to methimazole, underwent evaluation and treatment of thyroid storm and concomitant acute appendicitis. Aggressive initial treatment measures were started, including intravenous and oral propranolol. She went into cardiac arrest approximately six hours after initial medication administration, with subsequent return of spontaneous circulation achieved. The patient underwent aggressive resuscitation and multidisciplinary management. She had a prolonged course in the intensive care unit and was ultimately discharged from the hospital approximately three weeks later.

Beta-blocker use in the management of thyrotoxicosis can potentially cause cardiovascular collapse. We suggest consideration of shorter acting beta blockers, such as esmolol or landiolol.