Thyroid Biology and Disease

SUN-337 - Hidden Hyperthyroidism Unmasked: Thyroid Storm with Refractory Atrial Fibrillation Following Parathyroidectomy

Sunday, June 14, 2026

9:00 AM - 4:00 PM CT

Location: ENDOExpo; Poster Floor

Abstract Poster Presenter(s)

uday Shree Akkala Shetty, MBBS,MD

PRIME MAG SUBS SERVICES
Morrow, GA, United States

Co-Author(s)

AU

ASSAM ULLAH, M.D

Southern regional medical center
Morrow, Georgia, United States
sm

saptak mankad, MD

resident
Southern Regional Medical Center
Morrow, Georgia, United States
MP

Manya Pala, MD

Resident
Southern Regional Medical Center
Morrow, Georgia, United States
ab

aparna bondalapati, MBBS

Resident Physician
Southern Regional Medical Center
Morrow, Georgia, United States

Senior Author/Primary Investigator(s)

lk

lertdetkajorn khemaporn, MD

Endocrinologist
Southern Regional Medical Center
Atlanta, Georgia, United States

Co-Author(s)

FG

FNU Grish, MD

resident
Southern regional Medical Center
morrow, United States
sy

sreya yadlapalli, MD

resident
Southern Regional Medical center
mcdonough, Georgia, United States
FU

Fidelis Uwumiro, MD

Resident
Southern Regional Medical Center
Riverdale, Georgia, United States
Jj

Jay jani

Disclosure(s):

uday Shree Akkala Shetty, MBBS,MD: No financial relationships to disclose

Background:

Thyroid storm is a rare, life-threatening endocrine emergency with mortality rates up to 30% if untreated. Management may be particularly challenging in patients who develop thyrotoxicosis-induced low-output heart failure, as beta-adrenergic blockade can precipitate cardiogenic shock by eliminating compensatory sympathetic tone. Perioperative thyroid storm following non-thyroid surgery is exceedingly rare, especially in patients with unrecognized or subclinical hyperthyroidism.

Case Presentation:

A 70-year-old woman with primary hyperparathyroidism and subclinical hyperthyroidism underwent parathyroidectomy without preoperative thyroid imaging or antithyroid therapy. On postoperative day two, she developed acute agitation, hypotension (mean arterial pressure < 40 mmHg), and atrial fibrillation with rapid ventricular response (heart rate >200 bpm). Thyroid function tests revealed severe thyrotoxicosis (TSH 0.006 μIU/mL, free T4 >7.8 ng/dL, T3 17.2 ng/mL). Her Burch–Wartofsky Point Scale score was 65, consistent with thyroid storm.

She was transferred to the intensive care unit. Intravenous fluid bolus was administered. Due to persistent hypotension, beta-blockade was initially withheld. Synchronized electrical cardioversion for hemodynamically unstable atrial fibrillation was unsuccessful. Given refractory tachyarrhythmia, a carefully administered low-dose intravenous propranolol (1 mg) was given under close monitoring. The patient converted to sinus rhythm, with heart rate improving to the 110s and blood pressure stabilizing at 129/82 mmHg. She was subsequently treated with methimazole and stress-dose corticosteroids, resulting in clinical and biochemical improvement.

Conclusion:

This case illustrates a rare postoperative thyroid storm complicated by refractory atrial fibrillation and demonstrates that judicious low-dose propranolol may be lifesaving even in hypotensive patients when tachycardia is the principal cause of circulatory compromise. Comprehensive preoperative thyroid evaluation in hyperparathyroidism requiring surgical intervention may prevent severe perioperative complications.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*