SAT-394 Single Pass Albumin Dialysis for Refractory Amiodarone Induced Thyroid Storm

Abstract Disclosure: D. Moreno Watashi: None. D. Stasishin: None. A. Sehgal: None. W. Azzam: None. J. Ding: None. M.B. Sharma: None. Introduction: Thyroid storm is a potentially fatal condition requiring intensive care and treatment. Single Pass Albumin Dialysis (SPAD) is a highly effective but overlooked tool in the treatment of severe symptomatic thyrotoxicosis refractory to conventional therapy. However, this technique continues to be underutilized for this indication. We present a case of a patient with new-onset refractory amiodarone-induced thyrotoxicosis (AIT) precipitating thyroid storm, who was treated with SPAD. Case description: A 74-year-old male with a past medical history of coronary artery disease, ischemic cardiomyopathy, and chronic kidney disease was brought to the emergency department for shortness of breath and bilateral lower extremity swelling. He had been on amiodarone therapy for months. Labs on presentation demonstrated an undetectable TSH level, free thyroxine level of 9.68ng/dl, and a total triiodothyronine level of 309.5ng/dl. The patient was treated with maximal medical therapy including oral methimazole (120mg/day), intravenous hydrocortisone (300mg/day), Lugol’s Iodine, and Cholestyramine. Despite aggressive therapy, he showed poor response as evidenced by a slow decrease in free thyroxine levels from 10ngl/dl to 8.5ngl/dl. He then developed a non-fatal cardiac arrest due to ventricular tachycardia. Given his refractory thyroid storm, we performed SPAD daily for 5 days. Free thyroxine levels responded by decreasing over 50% from 8.5 ng/dl to 3.36 ng/dl. The patient had an improvement in symptoms as well. However, due to the protracted course of his thyroid storm and advanced ischemic cardiac disease, he eventually developed cardiogenic shock and passed away. Discussion: Extracorporeal blood purification therapies like plasmapheresis are known treatment options for hormonal removal. SPAD, most utilized for detoxification in liver failure, was introduced as a new therapy for refractory thyroid storm by Kotball et al1. Its ability to remove protein-bound toxins can provide consistent clearing of thyroid hormone, which is known to have a high binding affinity to albumin. SPAD has the advantage of not exposing patients to the risk of transfusion reactions seen in plasmapheresis. Severe thyrotoxicosis refractory to medical therapy is an indication for advanced treatment mechanisms such as SPAD. In our opinion, SPAD is a highly effective methodology and it should be utilized more frequently and earlier to reduce morbidity and mortality in thyroid storm. Presentation: Saturday, July 12, 2025