scholarly journals Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis

2016 ◽  
Vol 2016 ◽  
Author(s):  
Ling Zhu ◽  
Sueziani Binte Zainudin ◽  
Manish Kaushik ◽  
Li Yan Khor ◽  
Chiaw Ling Chng
Keyword(s):  
Plasma Exchange ◽  
Thyroid Storm ◽  
List Type ◽  
Type Ii ◽  
Free Triiodothyronine ◽  
Bridging Therapy ◽  
Session Type ◽  
Learning Points ◽  
Prompt Diagnosis

Summary Type II amiodarone-induced thyrotoxicosis (AIT) is an uncommon cause of thyroid storm. Due to the rarity of the condition, little is known about the role of plasma exchange in the treatment of severe AIT. A 56-year-old male presented with thyroid storm 2months following cessation of amiodarone. Despite conventional treatment, his condition deteriorated. He underwent two cycles of plasma exchange, which successfully controlled the severe hyperthyroidism. The thyroid hormone levels continued to fall up to 10h following plasma exchange. He subsequently underwent emergency total thyroidectomy and the histology of thyroid gland confirmed type II AIT. Management of thyroid storm secondary to type II AIT can be challenging as patients may not respond to conventional treatments, and thyroid storm may be more harmful in AIT patients owing to the underlying cardiac disease. If used appropriately, plasma exchange can effectively reduce circulating hormones, to allow stabilisation of patients in preparation for emergency thyroidectomy. Learning points Type II AIT is an uncommon cause of thyroid storm and may not respond well to conventional thyroid storm treatment. Prompt diagnosis and therapy are important, as patients may deteriorate rapidly. Plasma exchange can be used as an effective bridging therapy to emergency thyroidectomy. This case shows that in type II AIT, each cycle of plasma exchange can potentially lower free triiodothyronine levels for 10h. Important factors to consider when planning plasma exchange as a treatment for thyroid storm include timing of each session, type of exchange fluid to be used and timing of surgery.

scholarly journals Macroprolactinoma appearing after resolution of hydrocephalus

2017 ◽  
Vol 2017 ◽  
Author(s):  
Oscar D Bruno ◽  
Ricardo Fernández Pisani ◽  
Gabriel Isaac ◽  
Armando Basso
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Tumour ◽  
Empty Sella ◽  
List Type ◽  
Liquid Pressure ◽  
Final Size ◽  
Mechanical Factors ◽  
Pressure Resistance ◽  
Learning Points

Summary The role of mechanical forces influencing the growth of a pituitary adenoma is poorly understood. In this paper we report the case of a young man with hyperprolactinaemia and an empty sella secondary to hydrocephalia, who developed a macroprolactinoma following the relief of high intraventricular pressure. Learning points: The volume of a pituitary tumour may be influenced not only by molecular but also by local mechanical factors. Intratumoural pressure, resistance of the sellar diaphragm and intracranial liquid pressure may play a role in the final size of a pituitary adenoma. The presence of hydrocephalus may hide a pituitary macroadenoma.

scholarly journals Plasma exchange and early thyroidectomy in thyroid storm requiring extracorporeal membrane oxygenation

2019 ◽  
Vol 2019 ◽  
Author(s):  
Huilin Koh ◽  
Manish Kaushik ◽  
Julian Kenrick Loh ◽  
Chiaw Ling Chng
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Plasma Exchange ◽  
Beta Blockers ◽  
Thyroid Storm ◽  
Organ Support ◽  
List Type ◽  
Cardiovascular Collapse ◽  
Membrane Oxygenation ◽  
Multi Organ Failure

Summary Thyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure. Learning points: Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output. TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated. End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm. The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy.

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.

scholarly journals Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm

2019 ◽  
Vol 2019 ◽  
Author(s):  
Yuri Tanaka ◽  
Taisuke Uchida ◽  
Hideki Yamaguchi ◽  
Yohei Kudo ◽  
Tadato Yonekawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Transplantation ◽  
Plasma Exchange ◽  
Fulminant Hepatitis ◽  
Poor Prognosis ◽  
Interleukin 2 ◽  
Thyroid Storm ◽  
List Type ◽  
Interleukin 2 Receptor ◽  
Soluble Interleukin 2 Receptor

Summary We report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves’ disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis. Learning points: The prognosis of thyroid storm when fulminant hepatitis occurs is poor. Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange. Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.

scholarly journals Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature

2014 ◽  
Vol 2 (1) ◽  
pp. K1-K5 ◽  
Author(s):  
Ashraf Roshdy ◽  
Georgios T Karapanagiotidis ◽  
Mazin A I Sarsam ◽  
Simon N Fletcher
Keyword(s):  
Differential Diagnosis ◽  
Aortic Valve ◽  
List Type ◽  
Pannus Formation ◽  
Acute Obstruction ◽  
Review Of The Literature ◽  
Management Options ◽  
Diagnostic Modalities ◽  
Learning Points

SummaryAcute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management.Learning pointsAcute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

scholarly journals Vanishing hypercalciuric kidney stones after treating underlying acromegaly

2013 ◽  
Vol 2013 ◽  
Author(s):  
Eline van der Valk ◽  
Tom Tobe ◽  
Aline Stades ◽  
Alex Muller
Keyword(s):  
Calcium Oxalate ◽  
Kidney Stones ◽  
Common Finding ◽  
List Type ◽  
Primary Role ◽  
Short Overview ◽  
Learning Points

Summary A 53-year-old male presented with recurrent calcium oxalate kidney stones as a first sign of underlying acromegaly, which vanished when his acromegaly was controlled. The exact mechanism behind hypercalciuria and urolithiasis in acromegaly is not yet clear. By discussing this case, a short overview of the pathophysiology of hypercalciuria in acromegaly and practical insights are given. Learning points Hypercalciuria is a common finding in acromegaly. There are only few reports describing hypercalciuric kidney stones in acromegaly. We assume that in acromegaly there is a primary role of IGF1-mediated, PTH-independent increase in calcitriol synthesis resulting in hypercalciuric kidney stones.

scholarly journals Lugol's solution-induced painless thyroiditis

2017 ◽  
Vol 2017 ◽  
Author(s):  
Ji Wei Yang ◽  
Jacques How
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Graves Disease ◽  
List Type ◽  
Free T4 ◽  
Iodine Excess ◽  
Thyroid Glands ◽  
Painless Thyroiditis ◽  
Learning Points ◽  
Painful Thyroiditis

Summary Lugol’s solution is usually employed for a limited period for thyroidectomy preparation in patients with Graves’ disease and for the control of severe thyrotoxicosis and thyroid storm. We describe a rare case of Lugol’s solution-induced painless thyroiditis. In November 2014, a 59-year-old woman was prescribed Lugol’s solution four drops per day for the alleviation of menopausal symptoms. She was referred to our clinic in June 2015 for fatigue, hair loss, and a 20-lb weight loss without thyroid pain or discomfort. Physical examination revealed a normal thyroid gland. On 7 May 2015, laboratory tests revealed a suppressed thyroid-stimulating hormone (TSH) 0.01 U/L with elevated free T4 3.31 ng/dL (42.54 pmol/L). Repeat testing on 25 May 2015 showed spontaneous normalization of the free thyroid hormone levels with persistently low TSH 0.10 U/L. Following these results, a family physician prescribed methimazole 10 mg PO TID and very soon after, the TSH concentration rose to >100 U/L along with subnormal free T4 and T3 levels. Methimazole was promptly discontinued, namely within 18 days of its initiation. Over the course of the next few months, the patient spontaneously achieved clinical and biochemical euthyroidism. To our knowledge, this is a unique case of painless thyroiditis induced by Lugol’s solution, which has not been reported before. Lugol’s solution is a short-term medication given for the preparation of thyroidectomy in patients with Graves’ disease and for the control of severe thyrotoxicosis. Iodine excess can cause both hyperthyroidism and hypothyroidism. Rarely, Lugol’s solution can cause acute painless thyroiditis. Learning points: Lugol’s solution is used for thyroidectomy preparation in patients with Graves’ disease and for the control of severe thyrotoxicosis and thyroid storm. Iodine excess can cause both hypothyroidism and thyrotoxicosis. Thyroid glands with an underlying pathology are particularly susceptible to the adverse effect of iodine. The prolonged off-label use of Lugol’s solution can be harmful. Rarely, Lugol’s solution can cause acute painful thyroiditis.

Role of Plasma Exchange in the Thyroid Storm

2011 ◽  
Vol 15 (6) ◽  
pp. 522-531 ◽  
Author(s):  
Clotilde Muller ◽  
Peggy Perrin ◽  
Bernadette Faller ◽  
Sarah Richter ◽  
Francois Chantrel
Keyword(s):  
Plasma Exchange ◽  
Thyroid Storm

scholarly journals Thyroidectomy for the treatment of Graves’ thyrotoxicosis in thioamide-induced agranulocytosis and sepsis

2017 ◽  
Vol 2017 ◽  
Author(s):  
Colin L Knight ◽  
Shamil D Cooray ◽  
Jaideep Kulkarni ◽  
Michael Borschmann ◽  
Mark Kotowicz
Keyword(s):  
Thyroid Hormone ◽  
Total Thyroidectomy ◽  
Postoperative Recovery ◽  
Thyroid Storm ◽  
List Type ◽  
Hormone Levels ◽  
Life Threatening ◽  
Thyroid Hormone Levels ◽  
Stimulating Factor ◽  
Learning Points

A 51 year old man presented with sepsis in the setting of thioamide-induced agranulocytosis. Empiric broad-spectrum antibiotics was followed by directed narrow-spectrum antibiotics, and his neutrophil count recovered with support from granulocyte-colony stimulating factor (G-CSF) analogue transfusions. After a brief period of multi-modal therapy for nine days including potassium iodide (Lugol’s iodine), cholestyramine, propanolol and lithium to temper his persisting hyperthyroidism, a total thyroidectomy was performed while thyroid hormone levels remained at thyrotoxic levels. Postoperative recovery was uncomplicated and he was discharged home on thyroxine. There is limited available evidence to guide treatment in this unique cohort of patients who require prompt management to avert impending clinical deterioration. This case report summarises the successful emergent control of thyrotoxicosis in the setting of thioamide-induced agranulocytosis complicated by sepsis, and demonstrates the safe use of multi-modal pharmacological therapies in preparation for total thyroidectomy. Learning points: Thioamide-induced agranulocytosis is an uncommon but potentially life-threatening complication of which all prescribers and patients need to be aware. A multi-modal preoperative pharmacological approach can be successful, even when thioamides are contraindicated, when needing to prepare a thyrotoxic patient for semi-urgent total thyroidectomy. There is not enough evidence to confidently predict the safe timing when considering total thyroidectomy in this patient cohort, and therefore it should be undertaken when attempts have first been made to safely reduce thyroid hormone levels. Thyroid storm is frequently cited as a potentially severe complication of thyroid surgery undertaken in thyrotoxic patients, although the evidence does not demonstrate this as a common occurrence.

Mitochondria microcrystals deposition in some inherited diseases of lipid metabolism.

1978 ◽  
Vol 36 (2) ◽  
pp. 256-257
Author(s):  
S. Laoussadi ◽  
A. Kahan ◽  
G. Aubouy ◽  
F. Delbarre
Keyword(s):  
Synovial Tissue ◽  
Storage Disease ◽  
Metabolic Diseases ◽  
Uranyl Acetate ◽  
List Type ◽  
Type Ii ◽  
Type Number ◽  
Lipid Storage Disease ◽  
Thin Sections ◽  
Mean Size

Several patients with Fabry's, Gaucher's diseases and hyperlipoproteinemia type II and with arthropatic manifestations were observed.As no histological explanation for these symptoms was available,an ultrastructural study of synovial tissue was done to establish an anatomoclinical relation.Material and Methods :synovial membrane samples were obtained by needle biopsies of the knee from three patients with arthropatic manifestations of each disease.They were fixed in 5% glutaraldehyde, postfixed in 1% osmium tetraoxyde and embedded in Epon 812. Thin sections coloured by uranyl acetate and lead citrate were observed with an Elmiskop I Siemens electron microscope.Two important phenomena were observed in synovial tissue:Specific patterns of each lipid storage disease,which are now well known.In all the three metabolic diseases, hydroxyapatite-like crystals were found. They are characterized by their intramitochondrial localization, without any relation with cristae,an anarchic disposition and a mean size of 550 A.Crystals may be found also free in the cytoplasm of synoviocytes Some micrographs suggest an evolution in four steps :a. mitochondria with only a few microcrystalsb. mitochondria stuffed with these structuresc. disruption of mitochondria membranesd. microcrystals appear free in the cytoplasm

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