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{
    "pk": 41826,
    "title": "A Case Report of Thyroid Storm with Cardiovascular Collapse After Propranolol Administration",
    "subtitle": null,
    "abstract": "<p><strong>Introduction</strong>: Thyroid storm is a rare, life-threatening emergency with a 3.6-17% mortality rate despite proper management. Elevated levels of circulating thyroid hormones can increase metabolic demand, leading to adverse effects on multiple organ systems, particularly critical cardiovascular complications such as cardiomyopathy, myocardial infarction, ventricular arrhythmias, or coronary vasospasm. Precipitating factors can include infection, surgery, or trauma, with infection being the most common. The potential for cardiovascular mortality is high. While beta blockers are key for treatment, they can potentially reduce necessary cardiac output, risking hemodynamic collapse. Traditionally, propranolol has been recommended. We report a rare case of an adolescent experiencing cardiac arrest after propranolol administration in thyroid storm and acute appendicitis.</p>\n<p><strong>Case Report: </strong>A 17-year-old female with a history of Grave disease, non-adherent to methimazole, underwent evaluation and treatment of thyroid storm and concomitant acute appendicitis. Aggressive initial treatment measures were started, including intravenous and oral propranolol. She went into cardiac arrest approximately six hours after initial medication administration, with subsequent return of spontaneous circulation achieved. The patient underwent aggressive resuscitation and multidisciplinary management. She had a prolonged course in the intensive care unit and was ultimately discharged from the hospital approximately three weeks later.</p>\n<p><strong>Conclusion</strong>: Beta-blocker use in the management of thyrotoxicosis can potentially cause cardiovascular collapse. We suggest consideration of shorter acting beta blockers, such as esmolol or landiolol.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "case report"
        },
        {
            "word": "propranolol"
        },
        {
            "word": "Thyroid storm"
        },
        {
            "word": "appendicitis"
        },
        {
            "word": "beta blockers"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/7786n3st",
    "frozenauthors": [
        {
            "first_name": "Mark",
            "middle_name": "",
            "last_name": "Ringer",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California; Pomona Valley Hospital Medical Center, Department of Emergency Medicine, Pomona, California",
            "department": ""
        },
        {
            "first_name": "Tammy",
            "middle_name": "",
            "last_name": "Phan",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Emmelyn",
            "middle_name": "",
            "last_name": "Samones",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Brian",
            "middle_name": "",
            "last_name": "Wolk",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        }
    ],
    "date_submitted": "2025-01-13T17:47:55.110000+01:00",
    "date_accepted": "2025-05-30T22:25:31.333000+02:00",
    "date_published": "2025-08-18T22:00:00+02:00",
    "render_galley": null,
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            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/41826/galley/40139/download/"
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}