Total Thyroidectomy for Refractory Thyroid Storm: A Rare Case Report

Abstract

Graves’ disease is the leading cause of hyperthyroidism, predominantly affecting adult women. In rare situations, it may progress to thyroid storm, a severe endocrine emergency with high mortality, for which medical therapy is the first-line treatment. However, in refractory cases, surgery may be required. We present the case of a 56-year-old woman with poorly controlled Graves’ disease and two episodes of thyroid storm in two months. Despite optimized medical therapy, the patient maintained persistently elevated hormone levels and clinical manifestations. Given the lack of response, the multidisciplinary team decided to perform urgent total thyroidectomy. The procedure was uneventful from a surgical perspective, with only an increased need for intraoperative blood pressure control. The patient had a favorable postoperative course, with early discharge and stable condition under levothyroxine supplementation. This case highlights the importance of considering total thyroidectomy as a therapeutic option in patients with thyroid storm refractory to medical management. Although rare, this approach can be safely performed with appropriate multidisciplinary preparation, providing rapid and definitive metabolic control.