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Case report
Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis
  1. Vaishnavi Divya Nagarajan,
  2. Alba Morales,
  3. Lawtanya Pleasant and
  4. Asha Shenoi
  1. Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Vaishnavi Divya Nagarajan; divya.nagaraj{at}


Paediatric hyperthyroidism cases are mostly caused by Grave’s disease. Thyroid storm is a life-threatening condition seen rarely, in severe thyrotoxicosis, occurring in about 1%–2% of patients with hyperthyroidism. Antithyroid medications and beta-blockers are typically the first-line management of thyroid storm. We report a challenging case of a 15-year-old girl who presented with thyroid storm in the setting of septic shock and methimazole-induced agranulocytosis. Since the first-line agents were contraindicated, plasmapheresis was used to control the thyroid storm and as a bridging therapy to the definitive therapy of early thyroidectomy. This is the first paediatric case report that outlines the use of plasmapheresis in the management of complicated thyrotoxicosis in a setting of septic shock.

  • paediatrics (drugs and medicines)
  • drugs: endocrine system
  • thyrotoxicosis

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  • Contributors VDN coauthored this article with AS, AM and LP. There are no prior publications or submissions with any overlapping information. The idea for the article was conceived by all four authors. VDN did the literature search. VDN wrote the initial draft and the coauthors revised the complete draft multiple times. As the first and corresponding author, VDN will be the guarantor and responsible for all further communications. The case was managed by all the authors in different roles.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.