{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:54:34Z","timestamp":1782845674615,"version":"3.54.5"},"reference-count":10,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Thyroid storm is a life-threatening endocrine emergency that warrants early clinical recognition and aggressive intervention. We present a 64-year-old female with no known history of thyroid disease, who presented to her primary care physician with dyspnea on exertion and was found to have an anterior mediastinal mass. She had elective thymectomy. Pathology confirmed thymic lymphoepithelial carcinoma. Postoperatively, she developed altered mental status, fever, and atrial fibrillation with marked elevation of thyroid hormones, consistent with thyroid storm. She decompensated rapidly and was treated aggressively with standard therapies for thyroid storm, including beta-blockers, methimazole, cholestyramine, steroids, and iodine, with poor response. The patient eventually underwent 4 sessions of therapeutic plasma exchange (TPE) with marked improvement in her symptoms. This case reports a possible association between thymic lymphoepithelial carcinoma and Graves disease and highlights the utility of TPE in cases of severe thyroid storm that are refractory to traditional treatments. We learn from this case that evaluating thyroid function tests in patients with thymic or mediastinal masses before surgery might be helpful. TPE should be considered in patients with thyroid storm refractory to traditional therapies.<\/jats:p>","DOI":"10.1210\/jcemcr\/luad053","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T08:47:26Z","timestamp":1690966046000},"source":"Crossref","is-referenced-by-count":1,"title":["Refractory Thyroid Storm Due to Graves Disease in a Patient With Thymic Lymphoepithelial Carcinoma"],"prefix":"10.1210","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9590-2557","authenticated-orcid":false,"given":"Kenda","family":"Alkwatli","sequence":"first","affiliation":[{"name":"Cleveland Clinic Foundation, Division of Endocrinology, Diabetes, and Metabolism , Cleveland, OH 44106 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4576-4613","authenticated-orcid":false,"given":"Misbah","family":"Azmath","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, University of Connecticut School of Medicine , Farmington, CT 06032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6054-6636","authenticated-orcid":false,"given":"Prashant","family":"Grover","sequence":"additional","affiliation":[{"name":"Trinity Health of New England Medical Group, Division of Pulmonary and Critical care , Hartford, CT 06105 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1733-4253","authenticated-orcid":false,"given":"Pooja","family":"Luthra","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, University of Connecticut School of Medicine , Farmington, CT 06032 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"issue":"19","key":"2023080208472351700_luad053-B1","doi-asserted-by":"crossref","first-page":"4794","DOI":"10.3390\/cancers13194794","article-title":"Thymic lymphoepithelial carcinoma associated with Epstein-Barr virus: experiences and literature review","volume":"13","author":"Ose","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"10","key":"2023080208472351700_luad053-B2","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1172\/JCI119032","article-title":"Thymic hyperplasia in patients with Graves\u2019 disease: identification of thyrotropin receptors in human thymus","volume":"98","author":"Murakami","year":"1996","journal-title":"J Clin 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disease: a possible link between sustained hyperthyroidism and thymic neoplasia?","volume":"5","author":"Boyd","year":"2012","journal-title":"Thyroid Res"},{"issue":"5","key":"2023080208472351700_luad053-B7","first-page":"467","article-title":"Thyroid storm and incidental anterior mediastinal teratoma: coincidence or correlation?","volume":"29","author":"Wang","year":"2013","journal-title":"Acta Cardiol Sin"},{"issue":"7","key":"2023080208472351700_luad053-B8","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1001\/jama.1970.03180070041007","article-title":"Thyroid storm treatment with blood exchange and plasmapheresis","volume":"214","author":"Ashkar","year":"1970","journal-title":"J Am Med Assoc"},{"issue":"1","key":"2023080208472351700_luad053-B9","first-page":"86","article-title":"Therapeutic plasma exchange in refractory hyperthyroidism","volume":"10","author":"Sa\u00efe","year":"2021","journal-title":"Eur Thyroid 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