RT Journal Article SR Electronic T1 Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e235536 DO 10.1136/bcr-2020-235536 VO 13 IS 7 A1 Vaishnavi Divya Nagarajan A1 Alba Morales A1 Lawtanya Pleasant A1 Asha Shenoi YR 2020 UL http://casereports.bmj.com/content/13/7/e235536.abstract AB 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.