Abstract
Inappropriately treated impending thyroid storm can cause death to a patient. Therapeutic plasma exchange (TPE) is a good option to reverse this condition and help in the proper handling of the patient, though its indication not clearly defined. In this case report we share our experience of one case who was admitted in the department of endocrinology of BSMMU. The patients was diagnosed as a case of impending thyroid storm in which radio-iodine therapy could not be started as because of very poor clinical and laboratory report. Therapeutic plasma exchange was given in two sessions in one day interval by experienced medical staff and no complications. Main action of TPE is to remove the circulating putative antibodies, cytokines and thyroid hormones with their bound proteins. TPE has a brief effect and for this reason it should be connected with remaining thyroid blockers. When threatening symptoms arise TPE should be given as early as possible without hesitation and should not wait for effect of conventional treatment as because it rapidly improves the clinical conditions. We are also suggested to start TPE in a case of impending thyroid storm as because our study has proven the efficacy of TPE in the management of impending thyroid storm.
Keywords: Endocrinology, Plasma exchange, Thyroid storm, RPM, Plasmapheresis.
References
- Melmed, K. P. onsky, P. Larsen, and H. Kronenberg, Williams Textbook of Endocrinology, S. Mandel and P. Larsen, Eds., Elsevier, 12 edition, 2011.
- Muller, P. Perrin, B. Faller, S. Richter, and F. Chantrel, “Role of plasma exchange in the thyroid storm,” Terapeutic Apheresis and Dialysis, vol. 15, no. 6, pp. 522–531, 2011.
- Jha, S. Waghdhare, R. Reddi, and P. Bhattacharya, “Tyroid storm due to inappropriate administration of a compoundedthyroid hormone preparation successfully treated with plasmapheresis,” Tyroid, vol. 22, no. 12, pp. 1283–1286, 2012.
- Koball, H. Hickstein, M. Gloger et al., “Treatment of thyrotoxic crisis with plasmapheresis and single pass albumin dialysis: a case report: Toughts and progress,” Artifcial Organs, vol. 34, no. 2, pp. E55–E58, 2010.
- H. Min, A. Phung, T. J. Oh et al., “Terapeutic plasmapheresis enabling radioactive iodine treatment in a patient with thyrotoxicosis,” Journal of Korean Medical Science, vol. 30, no. 10, pp. 1531–1534, 2015.
- Carhill, A. Gutierrez, R. Lakhia, and R. Nalini, “Surviving the storm: two cases of thyroid storm successfully treated with plasmapheresis,” BMJ Case Reports, vol. 2012, 2012.
- S. Ashkar, R. B. Katims, W. M. Smoak, and A. J. Gilson, “Tyroid storm treatment with blood exchange and plasmapheresis,” Journal of the American Medical Association, vol. 214, no. 7, pp. 1275–1279, 1970.
- H. Lew, C.-J. Chang, J.-D. Lin, C.-Y. Cheng, Y.-K. Chen, and T.-I. Lee, “Successful preoperative treatment of a Graves’ disease patient with agranulocytosis and hemophagocytosis using double fltration plasmapheresis,” Journal of Clinical Apheresis, vol. 26, no. 3, pp. 159–161, 2011
- Schwartz, A. Padmanabhan, N. Aqui et al., “Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the american society for apheresis: the seventh special issue,” Journal of Clinical Apheresis, vol. 31, no. 3, pp. 149–162, 2016.
- Pimentel L, Hansen KN. Thyroid disease in the emergency department: a clinical and laboratory review. J Emerg Med 2004;28:201–9.
- Binimelis J, Bassas L, Marruecos L et al. Massive thyroxine intoxication: evaluation of plasma extraction. Intensive Care Med 1987;13:33–8.
- Puy H, Lamoryl J, Marcelli JM, Lalau JD, Debussche X, Quichaud J. Thyroid hormone extraction by plasma exchange. A study of extraction rate. Biomed Pharmacother 1992;46:413– 17.
- Schlienger JL, Faradji A, Sapin R et al. Treatment of severe hyperthyroidism by plasma exchange. Clinical and biological efficacy. 8 cases. Presse Med 1985;14:1271–4.
- Szczepiorkowski ZM, Bandarenko N, Kim HC et al. Ameri-can society for apheresis: apheresis application committee of the American society for apheresis. 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 2007;22:106– 75.
- Ashkar PS, Katims RB, Smoak WM, Gilson AJ. Thyroid storm treatment with blood exchange and plasmapheresis. JAMA 1970;214:1275–9.
- Kokuho T, Kuji T, Yasuda G. Thyroid storm-induced multiple orange failure relieved quickly by plasma exchange therapy. Ther Apher Dial 2004;8:347–9.
- Kuzuya N, Degroot LJ. Effect of plasmapheresis and steroid treatment on thyrotropin binding inhibitory immunoglobulins in a patient with exophthalmos and a patient with pretibial myxedema. J Endocrinol Invest 1982;5:373–8.
- Patte D, Läger FA, Savoie JC et al. Thyrotoxicosis, then hypothyroidism caused by iodine overload associated with neuropathy. Failure of plasma exchange. Ann Med Interne (Paris) 1983;134:31–4.
- Henderson A, Hickman P, Ward G, Pond SM. Lack of efficacy of plasmapheresis in a patient overdosed with thyroxine. Anaesth Intensive Care 1994;22:463–4
- Samaras K, Marel GM. Failure of plasmapheresis, corticoster-oids and thionamides to ameliorate a case of protracted amiodarone-induced thyroiditis. Clin Endocrinol 1996;45: 365–8.
- Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263– 77.
Corresponding Author
Dr Md. Ashraful Hoque
CMBT, MIS, DGHS