A51-13 Use of Pocus to Detect Thyrotoxicosis

Abstract Thyrotoxicosis occurs due to an excess amount of thyroid hormones triiodothyronine (T3) and thyroxine (T4). Clinical presentation can range from asymptomatic to life threatening thyroid storm. Untreated thyrotoxicosis can cause altered mental status, atrial fibrillation, thromboembolism, seizures, and death. Traditional diagnostic tools include measuring thyroid stimulating hormone, T3, T4, and antibody testing; however, we present a novel case of using point of care ultrasound in aiding in the diagnosis and treatment of thyrotoxicosis. With prompt recognition, this condition can be successfully treated before progressing to life threatening disease. A 49-year-old female with a past medical history significant for chronic hepatitis c, gerd, and recent diagnosis of hyperthyroidism presented to the emergency department with 1 week complaint of palpitations, fatigue, heat intolerance, loose stools, and weight loss. She was seen at urgent care 2 weeks prior with similar chief complaint, was found to have low TSH and asked to follow up with endocrinology outpatient; however, patient presented to the hospital due to recurrence of symptoms. She reported using Chinese herbal supplements for symptomatic relief in the time frame between her urgent care and emergency room visits but was unsure of the specific supplements. In the emergency department, her TSH was extremely low, with concomitant elevation in free T3 and T4. She presented with tachycardia and had aflutter with a 2-1 conduction, resistant to metoprolol. She was admitted to the ICU due to concern for thyroid storm. CT head and neck was done due to dysregulated thyroid labs. It showed enlarged thyroid gland, further imaging with ultrasound was recommended. Point of care ultrasound was done at bedside and demonstrated diffusely enlarged homogenous thyroid gland with hypervascularity, suggestive of an underlying thyrotoxicosis that can progress to a life-threatening thyroid storm if not promptly treated. This unique finding, in combination with the patient’s labs and clinical picture were consistent with thyrotoxicosis. Thyroid stimulating immunoglobulin, thyroid peroxidase, and thyroglobulin antibodies were elevated as well. Patient was able to have resolution of her symptoms with use of hydrocortisone, propranolol, and methimazole. Thyroid vascularization correlates with thyroid volume, with larger thyroids corresponding to increased vascularity. These patients are at higher risk for development of thyrotoxicosis. Use of POCUS allowed the patient’s diagnosis to be reached in a more prompt manner, and for immediate medical intervention to occur, demonstrating its efficacy. This abstract is funded by: None