How to do it: Plasmapheresis via venoarterial extracorporeal membrane oxygenation circuit for thyroid storm

Manuel, Lucy; Fong, Laura S.; Lahanas, Andrew; Grant, Peter

doi:10.1016/j.amsu.2021.102485

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…A review of the cases with the use of ECMO and other extra-corporeal systems in patients with severe thyrotoxicosis or thyroid storm has been summarized in Table 1 , including additional new cases reported from 2018 to 2021 ( 25 – 28 ) and conference poster reports ( 29 – 32 ). These 27 cases (inclusive of our case) showed survival in 85.2% (23 of the 27 cases), with survival in all four of the reported cases requiring additional extra-corporeal support of TPE or CRRT ( 4 – 7 ). ECMO was initiated for either cardiovascular collapse or circulatory shock, and lasted between 19 hours to 18 days.…”

Section: Discussionmentioning

confidence: 61%

“…Our patient is one of the few reported cases where multiple extra-corporeal systems were used (TPE, CRRT, and VA-ECMO) in TS management. On review of the medical literature of articles in English, there has only been four case reports describing the concurrent use of TPE and ECMO in patients with thyrotoxicosis with circulatory collapse ( 4 – 7 ), with one of them reporting the use of three extra-corporeal systems ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

Elmenyar,

Aoun,

Al Saadi

et al. 2023

Diagnostics

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Thyroid storm (TS) is a rare and fatal endocrine emergency that occurs due to undiagnosed and inadequately treated hyperthyroidism after stressful conditions in patients with thyroid disorders. The objective of this systematic scoping review was to better understand the pathophysiology of TS and its complications, in terms of myocardial affection, tachyarrhythmia, and cardiogenic shock. In addition, we explored the pharmacological, mechanical, and surgical treatments for TS. We also evaluated the outcomes of TS according to sex and cardiac involvement. Additionally, analytical analysis was performed on the selected data. A literature review of peer-reviewed journals was carried out thoroughly using medical terms, MeSH on PubMed, Google Scholar, and combinations such as thyrotoxicosis-induced cardiomyopathy, thyroid storm, cardiogenic shock, myocardial infarction, endocrine emergency, Burch–Wartofsky score, extracorporeal circulatory support, and thyroidectomy. A total of 231 papers were eligible (2 retrospective studies, 5 case series, and 224 case reports) with a total of 256 TS patients with cardiac involvement between April 2003 and August 2023. All age groups, sexes, patients with TS-induced cardiomyopathy, non-atherosclerotic myocardial infarction, tachyarrhythmia, heart failure, shock, and different forms of treatment were discussed. Non-English language articles, cases without cardiac involvement, and cases in which treatment modalities were not specified were excluded. Female sex was predominant, with 154 female and 102 male patients. Approximately 82% of patients received beta-blockers (BBs), 16.3% were placed on extracorporeal membrane oxygenation (ECMO) support, 16.3% received therapeutic plasma exchange (TPE), and 13.8% underwent continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVHD), or dialysis. Overall, 18 females and 16 males died. BB-induced circulatory collapse, acute renal failure, CRRT, and ventricular fibrillation were significantly associated with mortality. Awareness of TS and not only thyrotoxicosis is vital for timely and appropriate treatment. The early diagnosis and management of TS in cardiac settings, including pharmacological, mechanical, and surgical modalities, can save high-risk patients. Sex matters in the presentation, treatment, and mortality of this population. However, further large-scale, and well-designed studies are required.

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How to do it: Plasmapheresis via venoarterial extracorporeal membrane oxygenation circuit for thyroid storm

Cited by 2 publications

References 5 publications

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

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

Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock

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