From Stability to Storm: Thyroid Storm After a Decade of Antithyroid Drug
https://doi.org/10.15605/jafes.041.S1
- Author:
Jun Kit Khoo
1
;
Tharsini Sarvanandan
1
;
Ying Guat Ooi
1
;
Quan Hziung Lim
1
;
Carolyn Wai Ling Chee
1
;
Lee Ling Lim
1
;
Jeyakantha Ratnasingam
1
;
Shireene Ratna Vethakkan
1
;
Nicholas Ken Yoong Hee
1
Author Information
1. Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya
- Publication Type:Journal Article
- MeSH:
Antithyroid Agents;
Thyroid Crisis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):111-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Long-term antithyroid drug (LT-ATD) has emerged as
a feasible treatment strategy for patients who decline
radioactive iodine (RAI) or thyroidectomy for relapsed
or refractory Graves’ disease (GD). Benefits include
faster achievement of euthyroidism, lower risk of hypothyroidism, a more favorable cardiovascular profile, and
avoidance of surgical risks. Although fluctuations in
thyroid status may occur despite good compliance, thyroid
storm is exceedingly rare in patients on LT-ATD. While
there is no specific data on the incidence of thyroid storm
in this cohort, surveys suggest an overall low incidence
(0.2–0.76 cases per 100,000 annually). We report a patient
with stable GD who developed a thyroid storm despite
more than 10 years of LT-ATD.
Case:A 40-year-old female was diagnosed with GD 11 years
earlier during pregnancy. Treatment was stopped at 25
weeks’ gestation, but she relapsed at 7 months postpartum
and was started on carbimazole. She declined RAI or
surgery following a relapse and remained on carbimazole
5–10 mg daily, with good compliance. She presented with
a 1-day history of fever, cough, rhinorrhea, diarrhea, and
palpitations. She was compliant with carbimazole 5 mg
daily. On presentation, BP was 132/70 mmHg, HR 140
bpm, temperature 38.5°C, and SpO2 98% on air. She was
alert without agitation, had a diffuse goiter, mild proptosis,
and conjunctival injection, with otherwise normal
findings. Electrocardiogram showed sinus tachycardia.
Laboratory investigations demonstrated mild transaminitis,
leukocytosis, markedly elevated free T4 (>154 pmol/L),
suppressed thyroid-stimulating hormone (<0.008 mIU/L),
and elevated thyroid-stimulating immunoglobulin (2.25 IU/L, reference <0.55). Thyroid function tests 1 month ago
was normal. Her Burch-Wartofsky score was 60, consistent
with thyroid storm, likely precipitated by upper respiratory
tract infection. She improved with treatment and was
discharged with carbimazole 30 mg daily with planned
tapering, subsequently agreeing to RAI as definitive
treatment.
Conclusion:Infection may trigger thyroid storm despite good
compliance with LT-ATD. Patients should be counselled
regarding this risk and advised to seek early medical
attention if thyrotoxic symptoms recur.
- Full text:2026080508395395544EP_A164.pdf
