Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis

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 managemen...

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Bibliographic Details
Published in:BMJ case reports 2020-07, Vol.13 (7), p.e235536
Main Authors: Nagarajan, Vaishnavi Divya, Morales, Alba, Pleasant, Lawtanya, Shenoi, Asha
Format: Article
Language:English
Subjects:
Adolescent
Adrenergic receptors
Agranulocytosis - chemically induced
Antibiotics
Antithyroid Agents - adverse effects
Beta blockers
Case reports
Contraindications
Dysphagia
Endocrinology
Female
Graves Disease - complications
Graves Disease - drug therapy
Humans
Hyperthyroidism
Intubation
Iodine
Methimazole - adverse effects
Mortality
Novel Treatment (New Drug/Intervention
Established Drug/Procedure in New Situation)
Patients
Pediatrics
Plasma
Potassium
Sepsis
Sepsis - etiology
Thyroid Crisis - etiology
Thyroid gland
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Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-235536