8009 The Unravelling of a Perfect Storm: A Case of COVID-19 Induced Thyroid Storm Presenting as Heart Failure and Atrial Fibrillation

Abstract Disclosure: M. Parvez: None. A. Kavarthapu: None. S. nagpal: None. L. Makahleh: None. K. Pulivarthi: None. Introduction: Thyroid storm is an uncommon but life-threatening complication of hyperthyroidism characterized by a sudden and exaggerated release of thyroid hormones into the circulation. This leads to a cascade of systemic manifestations, including cardiovascular instability. Although rare, thyroid storm is associated with a high mortality rate, mainly due to its profound impact on the cardiovascular system. Case Presentation: A 55-year-old male with no significant past medical history presented to the ER after experiencing a syncopal episode while walking his dog. He reported experiencing fatigue, a weight loss of 10 lbs, and intermittent shortness of breath over the past couple of weeks. However, he denied having any fever, chills, cough, sputum production, chest pain, palpitations, orthopnea. The patient had not been under the care of any PCP and denied taking any medications, supplements like biotin, or had recent contrast exposure. Upon examination, the patient displayed a markedly elevated heart rate of 140 beats per minute, blood pressure of 142/86 mmHg, and a SpO2 of 99%. Coarse breath sounds and fine tremors were noted, but there was no lid lag, exophthalmos, pretibial myxoedema, muscle weakness, or thyroid tenderness. EKG confirmed the presence of atrial fibrillation with RVR. Further testing revealed a positive result for COVID-19 on the respiratory viral panel. Lab results showed elevated levels of High sensitivity Troponin I (301.8 ng/L), Total CK (1677 U/L), and ferritin (848.6 ng/mL), along with an undetectable level of TSH, FT4 of 4.0 ng/dL, and FT3 of 0.69 pg/mL. Based on these findings, a diagnosis of thyroid storm was made, and the patient was transferred to the ICU. The patient received a treatment regimen consisting of Methimazole, Metoprolol, dexamethasone intravenously. Thyroid antibody panel results was performed which showed elevated anti-TPO to 554 IU/mL. Thyroid US revealed a heterogeneous thyroid lobe with normal blood flow. Additionally, Echo results showed LVEF of 25% with severe global LV hypokinesis, suggesting dilated cardiomyopathy. The patient was started on GDMT. With treatment, his symptoms improved, and he reverted back to sinus rhythm. Subsequently, he was discharged with a Life-vest. Unfortunately, his LVEF did not improve, leading to the discussion for ICD placement. Conclusion: Thyroid storm is a rare but critical endocrine emergency that demands early recognition and intervention. This case illustrates the grave consequences of thyroid storm in a COVID-19 positive patient on the cardiovascular system, leading to heart failure and atrial fibrillation. Early recognition, prompt initiation of appropriate therapies are key to achieving favorable patient outcomes in the context of thyroid storm. Further research is needed to explore to enhance our understanding of the mechanisms underlying thyroid storm-induced cardiac complications. Presentation: 6/3/2024