Endocrine Abstracts

Introduction: Thyrotoxicosis can have profound systemic effects, with rare cases progressing to severe cardiac failure and multi-organ dysfunction. This report presents a 21-year-old female with untreated Graves’ disease who developed thyroid storm, leading to life-threatening complications. The case underscores the catastrophic consequences of untreated hyperthyroidism and the importance of timely intervention.

Case: The patient, diagnosed with Graves’ disease at 15 years and non-compliant with treatment for over a year, presented with fever, abdominal pain, and non-bloody diarrhoea following travel from Singapore. Investigations revealed TSH <0.01, FT4 >100 pmol/L, FT3 >50 pmol/L and TSH RAb 14.73 IU/L. She had a calculated Burch-Wartofsky Point Scale (BWPS) score of 80. She rapidly deteriorated, including cardiogenic shock, two pulseless electrical activity (PEA) arrests, and the need for veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Her course was complicated by severe left ventricular dysfunction (ejection fraction 15%), ECMO related ischemic calf muscle injury necessitating bilateral fasciotomies, rhabdomyolysis, acute renal failure, bilateral femoral deep vein thromboses, and infections requiring multiple debridement. Tracheal stoma breakdown and critical illness myopathy further prolonged her recovery. With aggressive thyroid management, including propylthiouracil, steroids, and beta-blockers, her cardiac function improved significantly, with an ejection fraction of 55% by day 20.

Conclusion: This case highlights the severe systemic consequences of untreated hyperthyroidism, notably its impact on cardiac function. It also emphasises the potential for recovery with timely, targeted thyroid management, even in the setting of critical illness. The interplay between thyroid dysfunction and multi-organ failure underscores the need for greater awareness and early intervention.