The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy
A thyroid storm is a medical emergency that requires high clinical suspicion and emergency treatment. We report an unusual case of thyroid storm and agranulocytosis managed with lithium therapy. The patient is a 32-year-old woman with a history of Graves’ disease on methimazole therapy who presented...
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| Format: | Article |
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SAGE Publishing
2025-04-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096251336657 |
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| author | Nikhil Vojjala MBBS, MD Omar Fathalla MD Mahvish Renzu MD Rishab Prabhu MD Lakshmi Kattamuri MD Geetha Krishnamoorthy MD Wael Taha MD |
| author_facet | Nikhil Vojjala MBBS, MD Omar Fathalla MD Mahvish Renzu MD Rishab Prabhu MD Lakshmi Kattamuri MD Geetha Krishnamoorthy MD Wael Taha MD |
| author_sort | Nikhil Vojjala MBBS, MD |
| collection | DOAJ |
| description | A thyroid storm is a medical emergency that requires high clinical suspicion and emergency treatment. We report an unusual case of thyroid storm and agranulocytosis managed with lithium therapy. The patient is a 32-year-old woman with a history of Graves’ disease on methimazole therapy who presented to the emergency department with fever and palpitations. She was diagnosed with COVID-19 infection a week ago. She was febrile and tachycardic with fine tremors on examination. Routine laboratory workup showed agranulocytosis. Serum thyroid-stimulating hormone levels are <0.01 µIU/ml (normal range is 0.45-5.33) with elevated T4 and T3 (10.4 pcg/ml [2.1-4.1 pcg/ml], 4.34 ng/dl [0.61-1.24 ng/dl]). Burch-Wartofsky Point Scale score was 60 points, highly suggestive of thyroid storm. A clinical diagnosis of thyroid storm was made. The precipitating factor in this case was identified as the recent COVID-19 infection. Adding to the conundrum is the co-existent agranulocytosis, precluding the usage of antithyroid medications. She was treated with beta-blockers, intravenous fluids, and steroid therapy to suppress T4 to T3 conversion. Lithium was started, given her neutropenia and thyroid storm. She responded to oral lithium therapy and was discharged. During follow-up, her symptoms were controlled and leucopenia resolved. In conclusion, COVID-19 is a recognized precipitating factor for thyroid storms. It is very rare to see co-existent thyroid storm and agranulocytosis, and lithium can be a useful option in such cases. This case report adds to the minimal literature existing on lithium use in patients with thyroid storm. |
| format | Article |
| id | doaj-art-2c9e8f17c75f4eaa9c65e605a2331d8d |
| institution | OA Journals |
| issn | 2324-7096 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj-art-2c9e8f17c75f4eaa9c65e605a2331d8d2025-08-20T02:29:51ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962025-04-011310.1177/23247096251336657The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium TherapyNikhil Vojjala MBBS, MD0Omar Fathalla MD1Mahvish Renzu MD2Rishab Prabhu MD3Lakshmi Kattamuri MD4Geetha Krishnamoorthy MD5Wael Taha MD6Trinity Health Oakland Hospital, Pontiac, MI, USARoss University School of Medicine, Bridgetown, BarbadosTrinity Health Oakland Hospital, Pontiac, MI, USATrinity Health Oakland Hospital, Pontiac, MI, USATexas Tech University Health Sciences Center at El Paso, USATrinity Health Oakland Hospital, Pontiac, MI, USADetroit Medical Centre, Wayne State University School of Medicine, MI, USAA thyroid storm is a medical emergency that requires high clinical suspicion and emergency treatment. We report an unusual case of thyroid storm and agranulocytosis managed with lithium therapy. The patient is a 32-year-old woman with a history of Graves’ disease on methimazole therapy who presented to the emergency department with fever and palpitations. She was diagnosed with COVID-19 infection a week ago. She was febrile and tachycardic with fine tremors on examination. Routine laboratory workup showed agranulocytosis. Serum thyroid-stimulating hormone levels are <0.01 µIU/ml (normal range is 0.45-5.33) with elevated T4 and T3 (10.4 pcg/ml [2.1-4.1 pcg/ml], 4.34 ng/dl [0.61-1.24 ng/dl]). Burch-Wartofsky Point Scale score was 60 points, highly suggestive of thyroid storm. A clinical diagnosis of thyroid storm was made. The precipitating factor in this case was identified as the recent COVID-19 infection. Adding to the conundrum is the co-existent agranulocytosis, precluding the usage of antithyroid medications. She was treated with beta-blockers, intravenous fluids, and steroid therapy to suppress T4 to T3 conversion. Lithium was started, given her neutropenia and thyroid storm. She responded to oral lithium therapy and was discharged. During follow-up, her symptoms were controlled and leucopenia resolved. In conclusion, COVID-19 is a recognized precipitating factor for thyroid storms. It is very rare to see co-existent thyroid storm and agranulocytosis, and lithium can be a useful option in such cases. This case report adds to the minimal literature existing on lithium use in patients with thyroid storm.https://doi.org/10.1177/23247096251336657 |
| spellingShingle | Nikhil Vojjala MBBS, MD Omar Fathalla MD Mahvish Renzu MD Rishab Prabhu MD Lakshmi Kattamuri MD Geetha Krishnamoorthy MD Wael Taha MD The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy Journal of Investigative Medicine High Impact Case Reports |
| title | The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy |
| title_full | The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy |
| title_fullStr | The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy |
| title_full_unstemmed | The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy |
| title_short | The Perfect Storm: Co-occurrence of Agranulocytosis and Thyroid Storm Successfully Managed with Lithium Therapy |
| title_sort | perfect storm co occurrence of agranulocytosis and thyroid storm successfully managed with lithium therapy |
| url | https://doi.org/10.1177/23247096251336657 |
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