MON-364 Thyroid storm: A retrospective cohort in a referral center in Mexico City

Abstract Disclosure: D. Cuenca: None. M. Aguilar Soto: None. J.M. Zuarth Vázquez: None. N.P. Lopez: None. B. Toy-Trejo: None. S. Gomez: None. N.M. Iniguez Ariza: None. Thyroid storm is a severe manifestation of thyrotoxicosis, associated with a with a 12-fold higher mortality rate compared to thyrotoxicosis without storm. The most common cause is Graves disease. It can be precipitated by non-compliance to medical therapy, acute iron load or severe stress like surgery, trauma or infection.Thyroid storm is diagnosed by a combination of thyroid function tests showing high total and free thyroid hormones and clinical signs of end-organ damage.Two validated severity rating scales for thyrotoxicosis are the classic Burch-Wartofsky Point Scale (BWPS) and the more recently published Japanese Thyroid Association (JTA) scale. A BWPS of ≥45 or JTA categories of thyroid storm 1 (TS1) or thyroid storm 2 (TS2) with evidence of systemic decompensation warrant aggressive therapy.We present a retrospective cohort of seventy-eight patients that presented with thyroid storm to a tertiary center in Mexico City.We included patients that presented with thyroid storm to the emergency department at a single center in Mexico City from 1999 to 2022. Patients were predominantly female (n=52, 24%) and the mean age was 31.8 years. Graves’ disease was the most frequent cause (n=66, 88%). Infection and antithyroid-drug discontinuation (69% and 24%, respectively) were the most frecquent triggering factors. Nineteen patients had no triggering factor identified. Treatment non-adherence was reported in 40 patients (57%). Only four patients were admitted to the ICU and the mortality rate was 6.49%, considerably lower than the reported in previous series. Thyroid storm was the initial presentation of hyperthyroidism in 18 patients (23%). Median Burch-Wartofsky point scale was 60 (IQR 50-67.4). Heart failure was present in 37%, CNS symptoms in 67%, and GI manifestations in 73%, but only 6 had altered liver function tests.In our series, mortality was significantly lower compared to other series (6.5 vs 25%). The age at the time of presentation was also lower in our cohort which could explain the better outcomes in our patients. In concordance to other studies, thyroid storm was the initial presentation in a high proportion of patients and non-adherence to treatment was common, but infection was the most common precipitating factor in our cohort. GI symptoms were the most common symptoms at presentation, but they were usually mild, followed by CNS symptom. Congestive heart failure was present in less than half of the patients, which was not concordant with other series in which CHF was more frequent. Thyroid storm is a life threatening condition that needs prompts admission and treatment. We present one of the largest single center cohorts that adds to the current knowledge of the disease. Presentation: Monday, July 14, 2025