Surviving the storm: two cases of thyroid storm successfully treated with plasmapheresis

Abstract

Thyroid storm is a rare, but critical, illness that can lead to multiorgan failure and carries a high death rate. The following case series describes two adult men with Graves’ disease who presented in thyroid storm and either failed or could not tolerate conventional medical management. However, both patients responded well to plasmapheresis, which resulted in clinical and biochemical stabilisation of their disease processes. The treatment option of plasmapheresis should be considered as a stabilising measure, especially when patients have failed or cannot tolerate conventional therapy. Plasmapheresis leads to amelioration of symptoms and a significant decline in thyroid hormone levels, providing a window to treat definitively with thyroidectomy.

Weathering the storm: A case of thyroid storm refractory to conventional treatment benefiting from therapeutic plasma exchange

“…The use of plasma and 5% albumin replacement fluids restores these proteins (ie, thyroid‐binding globulin, transthyretin, and albumin), providing binding sites for free thyroid hormone circulating in the plasma; ultimately this reduces the circulating pool of hormones available to bind tissue thyroid receptors. This therapeutic rationale prompted the decision to utilize both albumin, providing a large capacity for low affinity binding, and plasma, providing thyroid‐binding globulin with high affinity binding of thyroid hormone, as replacement solution for the initial TPE . Following the re‐emergence of clinical symptoms after the first procedure, the decision to utilize 100% plasma was made with the idea that the higher affinity thyroid‐binding globulin content of plasma would be more effective at reducing circulating levels of free thyroid hormone.…”

Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange

“…Thyroid storm due to primary thyroid gland dysfunction include hyperthyroid conditions such as Grave's disease or toxic multinodular goiter. Both primary dysfunctions have been successfully treated with TPE when used in conjunction with surgical management . Secondary causes such as surgery, infection, or trauma have been shown to be responsive to medical therapy, subsequently reducing the need for TPE.…”

Complications of Hyperthyroidism

“…Plasmapheresis leads to amelioration of symptoms and a significant decline in thyroid hormone levels, providing a window to treat definitively with thyroidectomy [323,324]. In each session only small amounts of thyroid hormones can be removed from the circulation, therefore plasmapharesis can be repeated.…”