Surviving the Storm: Two Cases of Thyroid Storm Successfully Treated with Plasmapheresis

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2012 Oct 23

PMID 23087271

Citations 13

Authors

Aubrey Carhill

Absalon Gutierrez

Ronak Lakhia

Ramaswami Nalini

Affiliations

Soon will be listed here.

Abstract

Thyroid storm is a rare, but critical, illness that can lead to multiorgan failure and carries a high death rate. The following case series describes two adult men with Graves' disease who presented in thyroid storm and either failed or could not tolerate conventional medical management. However, both patients responded well to plasmapheresis, which resulted in clinical and biochemical stabilisation of their disease processes. The treatment option of plasmapheresis should be considered as a stabilising measure, especially when patients have failed or cannot tolerate conventional therapy. Plasmapheresis leads to amelioration of symptoms and a significant decline in thyroid hormone levels, providing a window to treat definitively with thyroidectomy.

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References

Jiang Y, Hutchinson K, Bartelloni P, Manthous C . Thyroid storm presenting as multiple organ dysfunction syndrome. Chest. 2000; 118(3):877-9. DOI: 10.1378/chest.118.3.877. View

Brooks M, WALDSTEIN S, BRONSKY D, Sterling K . Serum triiodothyronine concentration in thyroid storm. J Clin Endocrinol Metab. 1975; 40(2):339-41. DOI: 10.1210/jcem-40-2-339. View

Mazzaferri E, SKILLMAN T . Thyroid storm. A review of 22 episodes with special emphasis on the use of guanethidine. Arch Intern Med. 1969; 124(6):684-90. DOI: 10.1001/archinte.124.6.684. View

Brooks M, WALDSTEIN S . Free thyroxine concentrations in thyroid storm. Ann Intern Med. 1980; 93(5):694-7. DOI: 10.7326/0003-4819-93-5-694. View

Lepore L, Agosti E, Pitacco F, PANIZON F . [Therapy with plasmapheresis and lymphoplasmapheresis combined with immunosuppressive agents in 2 cases of intractable juvenile rheumatoid arthritis]. Pediatr Med Chir. 1987; 9(3):321-4. View

Colebunders R, Bourdoux P, Bekaert J, Mahler C, PARIZEL G . Determination of free thyroid hormones and their binding proteins in a patient with severe hyperthyroidism (thyroid storm?) and thyroid encephalopathy. J Endocrinol Invest. 1984; 7(4):379-81. DOI: 10.1007/BF03351020. View

Choudhary A, Roberts I . Thyroid storm presenting with liver failure. J Clin Gastroenterol. 1999; 29(4):318-21. DOI: 10.1097/00004836-199912000-00004. View

Vyas A, Vyas P, Fillipon N, Vijayakrishnan R, Trivedi N . Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole-induced agranulocytosis. Endocr Pract. 2010; 16(4):673-6. DOI: 10.4158/EP09265.CR. View

Chong H, See K, Phua J . Thyroid storm with multiorgan failure. Thyroid. 2010; 20(3):333-6. DOI: 10.1089/thy.2009.0181. View

10.

Homma M, Shimizu S, Ogata M, Yamada Y, Saito T, Yamamoto T . Hypoglycemic coma masquerading thyrotoxic storm. Intern Med. 1999; 38(11):871-4. DOI: 10.2169/internalmedicine.38.871. View

11.

Szczepiorkowski Z, Winters J, Bandarenko N, Kim H, Linenberger M, Marques M . Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2010; 25(3):83-177. DOI: 10.1002/jca.20240. View

12.

Service F . Hypoglycemic disorders. N Engl J Med. 1995; 332(17):1144-52. DOI: 10.1056/NEJM199504273321707. View

13.

McLeod B, Sniecinski I, Ciavarella D, Owen H, Price T, Randels M . Frequency of immediate adverse effects associated with therapeutic apheresis. Transfusion. 1999; 39(3):282-8. DOI: 10.1046/j.1537-2995.1999.39399219285.x. View

14.

Izumi K, Kondo S, Okada T . A case of atypical thyroid storm with hypoglycemia and lactic acidosis. Endocr J. 2009; 56(6):747-52. DOI: 10.1507/endocrj.k09e-043. View

15.

Ashkar F, KATIMS R, SMOAK 3rd W, Gilson A . Thyroid storm treatment with blood exchange and plasmapheresis. JAMA. 1970; 214(7):1275-9. View

16.

LEPORE M, McKenna P, Martinez D, STUTMAN L, BONANNO C, CONKLIN E . Fulminant hepatitis with coma successfully treated by plasmapheresis and hyperimmune Australia-Antibody-rich plasma. Am J Gastroenterol. 1972; 58(4):381-9. View

17.

Petry J, van Schil P, Abrams P, Jorens P . Plasmapheresis as effective treatment for thyrotoxic storm after sleeve pneumonectomy. Ann Thorac Surg. 2004; 77(5):1839-41. DOI: 10.1016/S0003-4975(03)01246-3. View

18.

Herrmann J, Hilger P, KRUSKEMPER H . Plasmapheresis in the treatment of thyrotoxic crisis (measurement of half-concentration times for free and total T3 and T4). Acta Endocrinol Suppl (Copenh). 1973; 173:22. View

19.

Mercado M . Treatment of hyperthyroidism with a combination of methimazole and cholestyramine. J Clin Endocrinol Metab. 1996; 81(9):3191-3. DOI: 10.1210/jcem.81.9.8784067. View

20.

Spaulding S, Burrow G, BERMUDEZ F, Himmelhoch J . The inhibitory effect of lithium on thyroid hormone release in both euthyroid and thyrotoxic patients. J Clin Endocrinol Metab. 1972; 35(6):905-11. DOI: 10.1210/jcem-35-6-905. View