Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis

Jha, Sujeet; Waghdhare, Swati; Reddi, Rajashekhar; Bhattacharya, Priyanka

doi:10.1089/thy.2011.0353

Cited by 40 publications

(31 citation statements)

References 20 publications

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“…Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established. 21 There are a limited number of cases in the literature, [8][9][10][11][12][13][14][15][16][17][18][19][20] including one case demonstrating its use as a bridge toward definitive surgical treatment in a patient that could not attain euthyroid state. 11 TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines, and cytokines.…”

Section: Discussionmentioning

confidence: 99%

“…There are 13 cases of therapeutic plasma exchange (TPE) for thyroid storm or severe thyrotoxicosis in the literature. [8][9][10][11][12][13][14][15][16][17][18][19][20] In 1 case, a patient with congestive heart failure and supraventricular tachyarrythmia developed thyroid storm following administration of amiodarone, failed standard therapy for thyroid storm, and subsequently received TPE with an initial improvement in clinical state. However, the improvement was not sustained and the patient passed away from cardiac failure.…”

Section: Introductionmentioning

confidence: 99%

“…19 The remaining 12 cases of TPE for thyroid storm in the literature all demonstrated improved clinical response and decreased thyroid hormones following TPE. [8][9][10][11][12][13][14][15][16][17][18]20 However, TPE remains an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established. 21 Yet TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines, and cytokines 8 and is likely beneficial for these patients.…”

Section: Introductionmentioning

confidence: 99%

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

McGonigle

Tobian

Zink

et al. 2017

J of Clinical Apheresis

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Thyroid storm is a potentially lethal complication of hyperthyroidism with increased thyroid hormones and exaggerated symptoms of thyrotoxicosis. First-line therapy includes methimazole (MMI) or propylthiouracil (PTU) to block production of thyroid hormones as a bridge toward definitive surgical treatment. Untreated thyroid storm has a mortality rate of up to 30%; this is particularly alarming when patients cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy. Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature. Yet TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines and cytokines and is likely beneficial for these patients. We report a patient with thyroid storm who could not tolerate PTU, subsequently failed therapy with MMI, and was not appropriate for thyroidectomy. TPE was therefore performed daily for 4 days (1.0 plasma volume with 5% albumin replacement and 2 U of plasma). Over the treatment course, the patient's thyroid hormones normalized and symptoms of thyroid storm largely resolved; his T3 decreased from 2.27 to 0.81 ng/mL (normal 0.8-2.0), T4 decreased from 4.8 to 1.7 ng/mL (0.8-1.8), heart rate normalized, altered mental status improved, and he converted to normal sinus rhythm. He was ultimately discharged in euthyroid state. He experienced no side effects from his TPE procedures. TPE is a safe and effective treatment for thyroid storm when conventional treatments are not successful or appropriate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

McGonigle

Tobian

Zink

et al. 2017

J of Clinical Apheresis

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“…Due to the ongoing endogenous production, PE is rather considered a temporal relief therapy before definitive surgery. Taking in account the current observation of only small reductions in fT 4 and fT 3 and only insignificant reductions of fT 4 in one retrospective study [9] following PE, the utility of such a procedure has to be questioned, although it may be a life-saving procedure for thyroid storm in the case of intoxication [11]. …”

Section: Discussionmentioning

confidence: 99%

Changes of Thyroid Hormones and Their Binding Proteins during Plasma Exchange for Polyneuropathy in a Patient with Substituted Hypothyroidism due to Hashimoto's Thyroiditis

Jenni

Adler

Lanz

et al. 2015

Transfus Med Hemother

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Background: Pharmacodynamic studies and data concerning adaptation of thyroid substitution in patients with substituted hypothyroidism during plasma exchange (PE) is not available. Case Report: We measured TSH, fT₃ and fT₄, total T₄, thyroxin binding globulin (TBG), and albumin before and after 5 PE procedures in a 37-year-old women who underwent PE for a therapy-resistant polyneuropathy. Thyroxin was increased empirically by 8% resulting in a dose of 1.95 µg/kg per day. Results: Despite larger reductions of total T₄ and TBG over a series of 5 PEs (40-50% from baseline), only small reductions of 8% in fT₃ and fT₄ concentrations were documented with a concomittant increase in TSH level. Changes of fT₄, fT₃, and TSH remained within normal range. Conclusions: i) Despite a significant decrease in total thyroid hormone pool following PE, fT₄, fT₃, and TSH concentrations changed only slightly. ii) Based on this observation, a general increase in thyroid replacement therapy before PE cannot be recommended, but considered in case of a high normal TSH level.

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“…С целью снижения концентрации циркулирую-щих гормонов в крови применяют перитонеальный диализ и плазмаферез [13,27]. Эти методы должны применяться при развитии тяжелых побочных реак-ций на тиреостатики либо при необходимости про-ведения экстренной тиреоидэктомии.…”

Section: лечениеunclassified

Thyrotoxic crisis. Rare manifestations and the difficulties of timely diagnostics

Gazizova¹,

Васичкин²,

Харкенен³

et al. 2015

Clin Exp Thyroid

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Проявления тиреотоксикоза варьируют от стер-той клинической картины до развития полиорганной недостаточности. Тяжесть клинических проявлений определяют возраст пациента, скорость нарастания концентрации тиреоидных гормонов, наличие со-путствующих заболеваний и провоцирующего фак-тора [1]. Тиреотоксический криз (ТК) развивается, когда компенсаторных резервов организма становит-ся недостаточно для поддержания гомеостаза термо-регуляторной, сердечно-сосудистой и других систем [1]. Высокая смертность при данном состоянии тре-бует максимально ранней диагностики и незамедли-тельного назначения поликомпонентной терапии. Клиническая картина и диагностические критерии ТККлиническая картина при ТК во многом повто-ряет таковую при неосложненном тиреотоксикозе, однако проявления носят более тяжелый характер (табл. 1).Потливость и непереносимость высоких темпера-тур, наблюдаемые при типичном тиреотоксикозе, при ТК могут смениться лихорадкой до 40-41 °C и выра-женной потерей жидкости [2]. А синусовая тахи-кардия -предсердными нарушениями ритма сердца с различной степенью желудочковой дисфункции и развитием сердечной недостаточности [1].В большинстве случаев в анамнезе удается выя-вить провоцирующий фактор развития ТК. Опера-тивное вмешательство на щитовидной железе более не является основной пусковой причиной данного состояния, что связано с более широким применени-ем радиойодтерапии (РЙТ), а также внедрением обязательной подготовки пациентов с тиреотоксико-зом тиреостатиками [3]. По данным многоцентро-вого общенационального японского исследования, лидирующий провоцирующий фактор в настоящее Тиреотоксический криз (ТК) -редко встречающееся жизнеугрожающее осложнение тиреотоксикоза. Провоцирующим фактором развития ТК могут быть бесконтрольное прекращение приема тиреостатиков, оперативное лечение как на щитовидной железе, так и на других органах, присоединение инфекции, роды, введение йодсодержащих веществ. Многообразие клинических проявлений нередко приводит к несвоевременной диагностике, а вследствие этого и высо-кой смертности при данном состоянии. В статье представлены типичные и редкие проявления тиреотоксического криза, обобщены подходы к диагностике и лечению; описан клинический случай тиреотоксического криза у молодого мужчины.Клю че вые сло ва: тиреотоксический криз, шкала Бурха-Вартовского, лечение.Thyroid storm is a rare, life-threatening complication of thyrotoxicosis. It may be precipitated by an acute event such as discontinuation of antithyroid drug therapy, thyroid or nonthyroidal surgery, infection, parturition, or an acute iodine load. The variety of clinical presentations of this disorder can lead to delayed diagnostics and high mortality. The typical and atypical clinical manifestations, diagnosis, and management of thyroid storm will be reviewed here.It also describes a case study of a young man with thyroid storm.

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Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis

Abstract: The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably a life-saving treatment in patients who are exposed to amounts of thyroid hormone far in excess of that usually produced by the thyroid gland.

Cited by 40 publications

References 20 publications

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

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

Changes of Thyroid Hormones and Their Binding Proteins during Plasma Exchange for Polyneuropathy in a Patient with Substituted Hypothyroidism due to Hashimoto's Thyroiditis

Thyrotoxic crisis. Rare manifestations and the difficulties of timely diagnostics

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