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 Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems

2021 ◽  
Vol 12 ◽  
Author(s):  
Shir Lynn Lim ◽  
Kangjie Wang ◽  
Pak Ling Lui ◽  
Kollengode Ramanathan ◽  
Samantha Peiling Yang
Keyword(s):  
Plasma Exchange ◽  
Case Series ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Organ Support ◽  
Beta Blockade ◽  
Close Monitoring ◽  
Extra Corporeal Membrane Oxygenation ◽  
First Line ◽  
Membrane Oxygenation

Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.

The use of therapeutic plasma exchange for pediatric patients supported on extracorporeal membranous oxygenator therapy: A narrative review

Perfusion ◽  
2020 ◽  
pp. 026765912097432
Author(s):  
Reut Kassif Lerner ◽  
Uri Pollak
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Plasma Exchange ◽  
English Language ◽  
Pediatric Patients ◽  
Multiple Organ ◽  
Therapeutic Plasma Exchange ◽  
Cochrane Library ◽  
Membrane Oxygenation ◽  
Life Saving

Therapeutic plasma exchange in children is increasingly recognized as a life-saving treatment and is challenged by some technical considerations. As extracorporeal membrane oxygenation has been used for nearly half a century for refractory reversible respiratory and/or cardiac failure in both pediatric and adult populations, it may serve as an extracorporeal platform for therapeutic plasma exchange. It is most commonly described in patients with sepsis with multiple organ failure or thrombocytopenia associated multi organ failure. Additional pathophysiological processes of inflammatory and immunological storms might benefit from the combination of extracorporeal membrane oxygenation and plasma exchange. This is a nonmethodological review of English-language reports of therapeutic plasma exchange performed in patients supported by extracorporeal membrane oxygenation, both pediatric and adult, searching six databases, MEDLINE, Clinical Key, GOOGLE SCHOLAR, CINAHL, Cochrane library, and EMBASE.

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