S2452 Thyroid Storm-Induced Acute Liver Failure: A Systematic Literature Review of 23 Adult Case Reports

Introduction: Thyroid storm is a life-threatening emergency that can lead to multiorgan failure, including acute liver failure (ALF). While hepatic dysfunction is recognized in thyrotoxicosis, acute liver failure as a direct consequence remains poorly understood. There are no established management guidelines for this overlap, and existing literature is limited to scattered case reports. This systematic review aims to synthesize therapeutic strategies, and outcomes in adults presenting with thyroid storm complicated by ALF. Methods: A systematic search was conducted using PubMed, Google Scholar, Embase, Scopus and Web of Science databases on case reports showing a correlation between thyroid storm and acute liver failure. After thorough quality checks, 23 adult case reports were reviewed and relevant clinical and laboratory data, treatments, and outcomes were extracted and analyzed. Results: Among the 23 patients identified, 13 (56%) were woman and 10 (43%) were man, with a mean age in the mid-40s (range 22–66). A prior history of thyroid disease was present in 15 patients, while 7 were newly diagnosed. Graves disease was the underlying etiology in 17 cases (73.9%). All patients received medical therapy, including beta-blockers, corticosteroids, antithyroid drugs, and iodine agents; 8 (34.7%) underwent therapeutic plasma exchange. Thyroidectomy was performed in 5 cases, and 3 patients underwent liver transplantation. The overall survival rate was 73.9% (17/23). Recent cases have shown a growing utilization of plasma exchange, ECMO, and double plasma adsorption methods. Conclusion: Thyroid storm induced acute liver failure remains a rare but fatal complication, with high mortality if not promptly recognized and treated. Graves disease is the predominant etiology, and management requires early thyroid-directed therapy and aggressive liver support. Advanced extracorporeal therapies may improve outcomes, but standardized protocols are lacking. This review highlights the need for early clinical suspicion and development of a protocol for managing this crisis.