SAT-370 Total Thyroidectomy for Treatment of Impending Thyroid Storm

Abstract Disclosure: M. Hernandez Hernandez: None. V. Maldonado Torres: None. M.M. Mangual Garcia: None. A.N. Gonzalez Bossolo: None. Thyroid storm is a life-threatening complication that can occur in patients with untreated Graves' disease. It is a rare clinical presentation, with an incidence of 0.57 to 0.76 per 100,000 persons per year. After thyroid storm resolves, it is imperative to establish a definitive therapy for hyperthyroidism to prevent recurrence of thyrotoxicosis. The choice of definitive therapy should be individualized and discussed with patients to achieve better clinical outcomes. This case involves a 35-year-old female patient with a medical history of recently diagnosed Graves' disease (diagnosed one and a half months prior to evaluation), and bipolar disorder type II. She presented to the Emergency Room (ER) with complaints of shortness of breath and palpitations that had progressed over the past day, evolving into episodic chest pain one day before her arrival. The patient had been prescribed Methimazole 20 mg (one tablet orally daily) since her diagnosis of Graves' disease; however, she was not taking the medication due to significant adverse effects, including gastrointestinal disturbances and headaches. Upon arrival at the ER, her vital signs were notable for hypertension, and the EKG showed sinus tachycardia. The Burch-Wartofsky Scale resulted in a score of 30 points, consistent with impending thyroid storm. Thyroid function tests indicated suppressed TSH (<0.002 IU/mL) and elevated Free T4 values (3.18 ng/dL), with total T4 and T3 levels greater than 30 µg/dL. The patient was admitted to the Intensive Care Unit (ICU) for advanced care, including PTU, Propranolol, steroids, and Lugol's solution. The patient improved significantly over the subsequent days; however, while in the ICU, she experienced significant side effects from PTU, including abdominal pain and nausea. Additionally, due to physical exam findings of exophthalmos, where radioiodine therapy is contraindicated, options for definitive therapy were limited. The Endocrine Surgery service was consulted for a total thyroidectomy, which was performed while the patient remained hospitalized. No complications were identified after the total thyroidectomy, and the patient was started on Calcitriol and Calcium Carbonate oral supplements prior to surgery, which were to continue for 2 to 6 weeks to mitigate the risk of transient hypocalcemia afterward. Thyroid function tests post-discharge showed Free T4 values at 1.86 ng/dL, and the patient was discharged with Levothyroxine replacement and scheduled for follow-up at the Endocrinology clinic. In this case, it was important to individualize therapy since the patient did not benefit from radioiodine therapy or thionamides after discharge. Total thyroidectomy for the treatment of thyrotoxicosis is often considered a last resort management strategy. However, studies have demonstrated that it has low morbidity and should be considered a definitive therapy in these patients. Presentation: Saturday, July 12, 2025