Thyroid Storm‐induced Multiple Organ Failure Relieved Quickly by Plasma Exchange Therapy

Abstract

We report a 54-year-old female patient in whom thyroid storm was improved dramatically by plasma exchange. The patient presented with tachycardia, high fever and pulmonary congestion, in addition to left hemiparalysis and dysarthria. Serum thyroid hormone concentrations were markedly increased and computed tomography showed a fresh cerebral infarct, suggesting that she had thyroid storm precipitated by cerebral infarction. As there was no remarkable improvement even after 24 h of conventional therapy, plasma exchange was carried out using fresh frozen plasma. Consequently, her critical condition improved quickly. The half-life of thyroid hormones is so long that quick improvement is not always achieved even by sufficient doses of antithyroid drugs. Thus, plasma exchange in combination with conventional therapy appears to be effective in relieving the life-threatening state in our patient with thyroid storm precipitated by acute cerebral infarction.

A Case of Thyroid Storm with Multiple Organ Failure Effectively Treated with Plasma Exchange

“…In the present case, because only drug therapy was insufficient to control multi organ failure due to thyrotoxicosis, therapeutic plasma exchange was necessary. As previously mentioned, some reports have described the effectiveness of plasma exchange to thyroid storm (3)(4)(5). In plasma exchange a large amount of thyroid hormone binds serum protein and supplies fresh plasma to circulation instead of reducing thyroid hormone.…”

“…In cases of uncontrollable thyroid storm, some reports have described the effectiveness of plasma exchange (3)(4)(5). We encountered a case of thyroid storm accompanied with heart failure and liver dysfunction which was effectively treated with plasma exchange.…”

A mathematical model of pituitary–thyroid interaction to provide an insight into the nature of the thyrotropin–thyroid hormone relationship

“…plasmaphersis) could be predicted by Eq. (32) to reduce the value of T far more rapidly than achievable with standard therapy with ATD, given that T would fall along a parabolic curve with decreasing TSHRAb (Herrmann et al, 1973;Kokuho et al, 2004). In practice, plasma exchange can normalize total pool of T as rapidly as within several days because it not only removes TSHRAb (Atabay et al, 1993), but also removes the main protein-bound T reservoir (i.e.…”

How do I Diagnose and Manage Acute Endocrine Emergencies in the ICU?

“…61 As a final option, there are case reports describing the use of plasmapheresis, hemoperfusion, and plasma exchange as methods for rapidly reducing thyroid hormone levels in critically ill patients. [62][63][64] Antagonize Adrenergic Effects of Thyroid Hormone b-Adrenergic blockade remains a mainstay of therapy but should be used cautiously in patients with congestive heart failure. Propranolol (either orally or intravenously) is the preferred agent.…”