Endocrine Abstracts

JOINT2642

Introduction: Acute thyrotoxic crisis (ATC) is an exceptional form of life-threatening thyrotoxicosis. Its diagnosis is not easy to make, given its multisystemic and non-specific clinical manifestations. Its treatment requires specialized and urgent care, given the risk of single or multiple organ failure. We report the case of a patient with CAT complicated by cardiothyreosis.

Case report: Patient aged 30, known to have undocumented thyreopathy for 4 years, initially put on Carbimazole 20mg/d, taken irregularly then stopped for a period in view of hepatic cytolysis, then restarted 10 days ago in view of a normal hepatic workup. She presented to the emergency department with stageVI dyspnoea, palpitations, thermophobia and asthenia, in a context of significant weight loss. The workup revealed peripheral hyperthyroidism with TSH at 0.004 µUi/ml, T4L>64.3 pmol/land T3L at 17.7 pmol/l, with negative antibodies. the electrocardiogram showed supraventricular tachycardia at 220 bpm, with significant hepatic cytolysis. The patient underwent emergency conditioning, then was slowed by B-blockers (Propanolol) combined with an antiarrhythmic, and because of the hepatic cytolysis, which contraindicating the start of synthetic antithyroid drugs (ATDs), the patient had received corticosteroid therapy, combined with rehydration according to cardiac tolerance, and anticoagulation. And then, she underwent emergency plasmapheresis. The evolution was marked by a good clinico-biological improvement, electrocardiogram abnormalities and thyroid balance after the plasmapheresis session. Then, She underwent radical surgery after clinical stabilization and euthyroidism, with a simple postoperative course.

Discussion: ATC represents a veritable life-threatening emergency. Although rare, its mortality rate remains high (around 15%), mainly due to the onset of multivisceral failure. It is defined by an exacerbation of all the manifestations of thyrotoxicosis: fever, tachycardia, agitation, vomiting, dehydration, neuro-psychiatric disorders. Cardiothyreosis, is the most serious clinical presentation, occurs preferentially in the elderly. There are many causes, the most common being Graves’ disease, toxic goiter and amiodarone therapy. It is characterized by a drop in peripheral vascular resistance, an increase in resting heart rate, left ventricular contractility, blood volume and cardiac output. The most frequent and earliest sign is tachycardia, as well as atrial fibrillation, ventricular arrhythmias, pulmonary hypertension, orthostatic hypotension, right-predominant heart failure and coronary insufficiency.) In addition to specific treatments such as ATDs, radioactive iodine and surgery, the therapeutic arsenal includes symptomatic treatments: β-blockers as first-line therapy, digitalis, electrical cardioversion, even hemodynamic assistance and plasmapheresis.