Successful Treatment of Thyroid Storm with Plasmapheresis in a Patient with Methimazole-Induced Agranulocytosis

Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis

“…In a recent case of TS, plasmapheresis was done post surgery, where sleeve pneumonectomy was the precipitating event and the patient had not responded to standard antithyroid treatment (19). In another case, plasmapheresis was opted for in a patient with Graves' disease having methimazole-induced agranulocytosis worsening to pericarditis, thrombocytopenia, and, finally, TS (17). While plasmapheresis was decidedly a therapeutic option, the challenge lay in the fact that plasmapheresis could potentially lead to hypocalcemia, which, in turn, could cause seizures.…”

“…It has been used in preoperative and post-operative management of severely hyperthyroid patients with contraindications to antithyroid drugs (13). It has also been used for the management of TS, predominantly in patients with Graves' disease with ophthalmopathy (14,15) or agranulocytosis (16,17) and in selected patients with toxic multinodular goiter (18). In a recent case of TS, plasmapheresis was done post surgery, where sleeve pneumonectomy was the precipitating event and the patient had not responded to standard antithyroid treatment (19).…”

Patient Knowledge of Antithyroid Drug-Induced Agranulocytosis

“…Review of the literature of reported cases of agranulocytosis between 1999 and 2013 identified 80 cases where the presenting symptoms were described [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Fever (93.8%), sore throat (68.7%) and chills (21.2%) were the commonest presenting symptoms.…”

Management of Severe Thyrotoxicosis When the Gastrointestinal Tract Is Compromised

“…In addition, removal of circulating TSH receptor stimulating antibodies could be another possible mechanism leading to improvement in thyrotoxicosis (41). It was noted that the clinical improvement of thyrotoxicosis is more significant than the improvement of thyroid hormone levels after PP/TPE (37,39). The effect of PP/TPE on thyrotoxicosis is transient, lasting approximately 24-48 hours.…”

“…Both procedures can effectively reduce circulating thyroid hormone levels within 3 days (37)(38)(39). Thyroid hormones are bound to plasma proteins.…”