Thyrotoxicosis induced cardiomyopathy requiring support with extracorporeal membrane oxygenation

White, Abigail; Bozso, Sabin J.; Moon, Michael

doi:10.1016/j.jcrc.2018.01.026

Cited by 11 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of ECMO had a trend towards increased mortality (2.86, CI 0.69-11.92), with a mortality of 72.2% among 13 of 18 patients, as compared to 9.3% in patients not requiring ECMO ( 39 ). These numbers, albeit small, suggest a significantly higher mortality in patients requiring use of extra-corporeal systems, and this differs from the established mortality rate of 10-30%, and vary significantly from the numbers in our review and White et al.’s review in patients requiring ECMO ( 21 ). Similarly Muller et al.…”

Section: Discussioncontrasting

confidence: 91%

“…Three patients survived, with normalization of thyroid function and improved cardiovascular function. A subsequent review by White et al (21) published in 2018 reported the successful use of ECMO with survival in 11 out of 14 patients (22)(23)(24) between 1970 to 2017 with thyrotoxicosis-induced cardiomyopathy, with near complete recovery of left ventricular function. 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)(26)(27)(28) and conference poster reports (29)(30)(31)(32).…”

Section: Evidence Of Use Of Extra-corporeal Systems In Tsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 91%

Section: Evidence Of Use Of Extra-corporeal Systems In Tsmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…White et al . performed a systematic review in which there were a 78.5% survival rate and near complete recovery of left ventricular function; these patients were managed with VA-ECMO [ 31 ]. The main drawback observed by the researchers was elevated after load on the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Management of Cardiogenic Shock due to Thyrotoxicosis: A Systematic Literature Review

Modarresi

Amro²,

Amro³

et al. 2021

CCR

View full text Add to dashboard Cite

Background: A grave complication of thyrotoxicosis, or thyroid storm, is the development of heart failure and cardiomyopathy. Recognizing this condition is imperative in preventing further left ventricular dysfunction and cardiogenic shock. This manuscript aims to review the literature on cardiogenic shock associated with thyrotoxicosis and present management recommendations on this rare condition. Method: A literature search was performed in December of 2018, using the PubMed medical search engine. A systematic search was carried out using the keywords Thyroid Storm AND Cardiogenic Shock and Thyrotoxicosis AND Shock. Management: A) Decrease of thyroid hormone levels using therapeutic plasma exchange B) LV Unloading and ventilation by Impella and Extracorporeal Mechanical Ventilation (ECMO). Conclusion: Patients presenting with thyroid storm-induced shock may not be suitable candidates for traditional management with β-adrenergic blockers (β-blockers). Use of β-blockers could exasperate their condition. Through extensive literature review on this rare condition, the most effective management was found to be therapeutic plasma exchange in order to decrease thyroid hormone levels, which have direct toxic effect on the heart. Furthermore, the use of ECMO and Impella are advised to reduce pressure on the heart and ensure the patient’s organs are well oxygenated and perfused while the left ventricle is recovering.

show abstract

“…Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) helps maintain sufficient end-organ perfusion and is an efficacious treatment for patients with severe cardiogenic shock from causes including post-cardiac surgery, acute myocardial infarction, myocarditis, and post-cardiac arrest [ 7 – 9 ]. The role of ECMO in circulatory collapse resulting from endocrine emergencies remains unclear [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Thyrotoxicosis-Induced Cardiomyopathy Complicated by Refractory Cardiogenic Shock Rescued by Extracorporeal Membrane Oxygenation

et al. 2021

View full text Add to dashboard Cite

Patient: Male 53-year-old Final Diagnosis: Thyrotoxicosis-induced cardiomyopathy Symptoms: Dyspnea Medication:— Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine Objective: Unusual clinical course Background: Thyrotoxicosis-induced cardiomyopathy is a rare but potentially life-threatening condition that occurs in less than 1% of thyrotoxic individuals. Severely impaired left ventricular systolic function can lead to an overt cardiogenic shock requiring mechanical circulatory support. Abnormal cardiac structure and function are potentially reversible after achievement of euthyroid state. Case Report: We present a case of a 53-year-old patient with a diagnosis of thyrotoxicosis-induced acute heart failure. Transthoracic echocardiography revealed a mildly dilated left ventricle and severely reduced systolic function with ejection fraction of 20%. Subsequently, the patient developed refractory cardiogenic shock, which was treated with the use of extracorporeal membrane oxygenation (ECMO). After early intensive treatments to achieve euthyroid state, the clinical status significantly improved. Echocardiography prior to discharge showed improvement of left ventricular ejection fraction to 40%. The anti-TSH receptor was positive and Grave’s disease was diagnosed. The patient eventually returned to baseline functional status and could return to basic activities of daily living without limitations. Conclusions: Early diagnosis of cardiac involvement in patients with thyrotoxicosis is critical. Promptly delivered intensive treatment with rapid achievement of euthyroid state can reverse cardiac dysfunction and improve patient outcomes. The use of ECMO can be considered as a “bridge” to recovery of cardiac function after restoration of euthyroid state.

show abstract

Thyrotoxicosis induced cardiomyopathy requiring support with extracorporeal membrane oxygenation

Cited by 11 publications

References 10 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

Management of Cardiogenic Shock due to Thyrotoxicosis: A Systematic Literature Review

Thyrotoxicosis-Induced Cardiomyopathy Complicated by Refractory Cardiogenic Shock Rescued by Extracorporeal Membrane Oxygenation

Contact Info

Product

Resources

About