Perfect storm: Therapeutic plasma exchange for a patient with thyroid storm

2017 ◽  
Vol 33 (1) ◽  
pp. 113-116 ◽  
Author(s):  
Andrea M. McGonigle ◽  
Aaron A. R. Tobian ◽  
Jennifer L. Zink ◽  
Karen E. King
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Perfect Storm

scholarly journals THERAPEUTIC PLASMA EXCHANGE AS A BRIDGE TO TOTAL THYROIDECTOMY IN PATIENTS WITH SEVERE THYROTOXICOSIS

2020 ◽  
Vol 6 (1) ◽  
pp. e14-e18
Author(s):  
Kelsey Tieken ◽  
Ameena Madan Paramasivan ◽  
Whitney Goldner ◽  
Ana Yuil-Valdes ◽  
Abbey L. Fingeret
Keyword(s):  
Total Thyroidectomy ◽  
Plasma Exchange ◽  
Medical Management ◽  
Response To Therapy ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Average Percentage ◽  
The Mean ◽  
Definitive Management

Objective: Graves disease is the most common cause of thyrotoxicosis. Medical management is the first-line treatment but may be contraindicated or ineffective. In patients with severe, refractory thyrotoxicosis therapeutic plasma exchange (TPE) may be indicated as a bridge to thyroidectomy. Methods: We present 3 cases of thyrotoxicosis refractory to medical management that were successfully treated with TPE and subsequent total thyroidectomy, and provide an analysis of the response to therapy via a change in free thyroxine (fT4) levels throughout their treatment course. Results: The average change in fT4 per liter of fluid exchanged was 0.37 ng/dL (SD = 0.08) and the average percentage change of fT4 after each treatment was 20.7% (SD = 8.28). The mean decrease in fT4 after 4 TPE treatments was 57.4%. All patients successfully underwent total thyroidectomy without complication and were discharged from the hospital. Conclusion: TPE should be considered for thyrotoxic patients with severe hyperthyroidism or thyroid storm refractory to medical management or contraindications to antithyroid drugs who need a bridge to total thyroidectomy. In these cases, TPE was a safe and effective treatment that enabled definitive management with thyroidectomy and may be considered in other patients with severe refractory hyperthyroidism or thyrotoxicosis.

scholarly journals SURVIVING THE STORM: USE OF THERAPEUTIC PLASMA EXCHANGE IN THYROID STORM

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A1000 ◽  
Author(s):  
Anvitha Ankireddypalli ◽  
Praveen Kumar Vikraman ◽  
Harsh Mehta
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm

Therapeutic plasma exchange for control of thyroid storm

2020 ◽  
Author(s):  
Alvin W. K. Tan ◽  
Brenda S. P. Lim ◽  
Jeremy K. M. Hoe ◽  
Wai H. Hoi ◽  
Melvin K. S. Leow
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm

TREATMENT OF THYROID STORM WITH THERAPEUTIC PLASMA EXCHANGE

CHEST Journal ◽  
2019 ◽  
Vol 156 (4) ◽  
pp. A855
Author(s):  
Richard Stringer ◽  
Stephen Doyle ◽  
Emily Amin
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm

scholarly journals Thyroid storm with delayed hyperbilirubinemia and severe heart failure: indication and contraindication of plasma exchange

2020 ◽  
Vol 2020 ◽  
Author(s):  
Tomomi Nakao ◽  
Ken Takeshima ◽  
Hiroyuki Ariyasu ◽  
Chiaki Kurimoto ◽  
Shinsuke Uraki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Plasma Exchange ◽  
Hepatic Failure ◽  
Severe Heart Failure ◽  
Acute Hepatic Failure ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Serum Total Bilirubin ◽  
List Type

Summary Thyroid storm (TS) is a life-threatening condition that may suffer thyrotoxic patients. Therapeutic plasma exchange (TPE) is a rescue approach for TS with acute hepatic failure, but it should be initiated with careful considerations. We present a 55-year-old male patient with untreated Graves’ disease who developed TS. Severe hyperthyroidism and refractory atrial fibrillation with congestive heart failure aggregated to multiple organ failure. The patient was recovered by intensive multimodal therapy, but we had difficulty in introducing TPE treatment considering the risk of exacerbation of congestive heart failure due to plasma volume overload. In addition, serum total bilirubin level was not elevated in the early phase to the level of indication for TPE. The clinical course of this patient instructed delayed elevation of bilirubin until the level of indication for TPE in some patients and also demonstrated the risk of exacerbation of congestive heart failure by TPE. Learning points: Our patient with thyroid storm could be diagnosed and treated promptly using Japan Thyroid Association guidelines for thyroid storm. Delayed elevation of serum bilirubin levels could make the decision of introducing therapeutic plasma exchange difficult in cases of thyroid storm with acute hepatic failure. The risk of worsening congestive heart failure should be considered carefully when performing therapeutic plasma exchange.

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