AN ALTERNATIVE ROUTE OF TREATMENT FOR REFRACTORY VASODILATORY SHOCK DUE TO THYROID STORM

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Thyroid storm is a rare life-threatening thyrotoxicosis accounting for 16.2% of hospital admissions involving hyperthyroidism. Mortalities rates in thyroid have been found to be between 8-25%. This case involves patient refractory vasodilatory shock from requiring rectal propylthiouracil (PTU) with rapid resolution shock. CASE PRESENTATION: 54-year-old woman history secondary Grave's disease, persistent atrial fibrillation, heart failure reduced ejection fraction, polysubstance abuse, presented initially dyspnea and tachycardia, fibrillation ventricular response thyrotoxicosis. She reported not taking her home medications two weeks prior admission as well using cocaine intermittently. Her Burch-Wartofsky score was 65, consistent storm. started on oral cholestyramine, methimazole, propranolol, SSKI drops, intravenous hydrocortisone. Within eight hours she decompensated multiple vasopressors transfer intensive care. On day three due concern inadequate absorption while four high dose vasopressors. 24 receiving PTU needed minimal norepinephrine maintain normal mean arterial pressure. Two later underwent an I-131 radioactive iodine ablation subsequently discharged home. DISCUSSION: Treatment blocking hormone synthesis, release, conversion T4 T3, decreasing the systemic effects. Majority therapies available require are always readily formulations. A study by Jongjaroenprasert et al. successful treatment fifteen clinic patients hyperthyroidism administration PTU. Prior this had given ten times literature. report published 2006 complicated perforated gastric ulcer who successfully treated Intravenous formulations both methimazole also potential possibilities explore should options inadequate, but these often available. If continued deteriorate, or developed toxicities PTU, would therapeutic plasma exchange (TPE). While therapy has limited evidence support TPE storm, American Society Apheresis recommends initiating if first second line medical fail within 24-48 treatment. CONCLUSIONS: Rectal practical alternative can safely administered critically ill REFERENCE #1: Galindo, R.J., al., National Trends Incidence, Mortality, Clinical Outcomes Patients Hospitalized Thyrotoxicosis With Without Storm United States, 2004-2013. Thyroid, 2019. 29(1): p. 36-43. #2: Jongjaroenprasert, W., hyperthyroid patients: comparison suspension enema suppository form. 2002. 12(7): 627-31. #3: Zweig, S.B., form critical illness: review Endocr Pract, 2006. 12(1): 43-7. DISCLOSURES: No relevant relationships Hannah Leschorn, source=Web Response Seema tekwani, Amanda Wiggins,