Open AccessSepsis and thyroid storm in a patient with methimazole-induced agranulocytosis
Author(s) -
Vaishnavi Nagarajan,
Alba Morales,
Lawtanya Pleasant,
Asha Shenoi
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2020-235536
Subject(s) - thyroid storm , medicine , graves' disease , septic shock , antithyroid drugs , plasmapheresis , sepsis , pediatrics , thyroid , thyroidectomy , intensive care medicine , surgery , immunology , antibody
Paediatric hyperthyroidism cases are mostly caused by Grave's disease. Thyroid storm is a life-threatening condition seen rarely, in severe thyrotoxicosis, occurring in about 1%-2% of patients with hyperthyroidism. Antithyroid medications and beta-blockers are typically the first-line management of thyroid storm. We report a challenging case of a 15-year-old girl who presented with thyroid storm in the setting of septic shock and methimazole-induced agranulocytosis. Since the first-line agents were contraindicated, plasmapheresis was used to control the thyroid storm and as a bridging therapy to the definitive therapy of early thyroidectomy. This is the first paediatric case report that outlines the use of plasmapheresis in the management of complicated thyrotoxicosis in a setting of septic shock.