PSAT317 An Impending Thyroid Storm Caused by COVID-19 Infection

BACKGROUND: Thyroid storm is an acute, potentially fatal complication of hyperthyroidism, usually manifested with tachycardia, hyperthermia, and altered mental status. Despite medical advancements, the mortality associated with thyroid storms remained 5% to 25%. Previously, cases of thyroiditis following COVID-19 infection have been reported. But the manifestation of COVID-19 infection as a thyroid storm is infrequent, and less than 5 cases have been reported to date. CASE: A 72-year-old female with a remote history of breast cancer status post-mastectomy presented to the emergency department with the chief complaint of shortness of breath. She was found to have a history of fever eight days before the presentation; she was also complaining of non-productive cough, non-bloody, and non- bilious vomiting, myalgia, and fatigue. Home Covid Test was positive. On the day of the presentation, she received Regeneron infusion (casirivimab and imdevimab) and was discharged home. After a few hours, she represented to the hospital with chills and worsening of shortness of breath. She was found to be hypoxic on the presentation, was started on O2 supply, and transferred to the ICU. She received IV dexamethasone 6 mg and IV Remdesivir 200 mg on the first day, followed by 100mg for the next four days. On the fourth day following admission, she developed Atrial Fibrillation with a rapid ventricular response. The patient was somnolent and had loose bowel movements. Thyroid function tests were ordered; TSH was 0.02 and free T4 of 2.9. She stated she was never diagnosed with a thyroid disorder in the past. Thyroid function tests were ordered, which are mentioned in the table below. A thyroid-stimulating antibody assay was ordered to rule out Graves thyrotoxicosis, which turned out to be normal. Ultrasound of the thyroid gland didn't reveal any abnormalities. CONCLUSION: Although most patients remain euthyroid during COVID-19 infection, some may have shown transient thyroid derangements during the illness, which later turns out to be normal. Our case shows that a clinician should not take the thyroid derangements in COVID-19 lightly, as they can be the early signs of an impending thyroid storm. Our case guides the clinician to evaluate the thyroid function as soon as possible in any signs of overt hyperthyroidism. Due to the high mortality associated with thyroid storm, a clinician should have a high index of suspicion to diagnose the storm, such as in our case where other signs of hyperthyroidism are absent. Early treatment of thyroid storms becomes necessary to mitigate the mortality in such cases. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.