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

Wyble, Aaron; Moore, Steven C.; Yates, Sean G.

doi:10.1002/jca.21658

Cited by 6 publications

(2 citation statements)

References 28 publications

(91 reference statements)

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“…Five patients had an Impella device installed, and 9.3% had an intra-aortic balloon pump. Chaaya et al, Ahmad et al, and Korte et al reported the use of a left ventricular assist device [43,73,237]. In terms of other thyroid-related procedures, 18.6% of the patients underwent thyroidectomy, whereas 3.3% received RAI.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…demonstrated the use of therapeutic plasma exchange to decrease the thyroid hormone levels in a patient with cardiogenic shock secondary to thyrotoxicosis [ 8 ]. It has been well documented that in patients with acute thyrotoxicosis, therapeutic plasma exchange can remove thyroid hormones as well as thyroid gland autoantibodies, catecholamines and cytokines [ 19 , 20 , 30 , 36 ]. In research by Subahi et al ., a four-step algorithm was created for the management of thyrotoxic crisis [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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

Modarresi

Amro²,

Amro³

et al. 2021

CCR

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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.

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Thyroid Storm

Princi

Koutelidakis

2021

Endocrine Surgery Comprehensive Board Exam Guide

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

Cited by 6 publications

References 28 publications

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

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

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

Thyroid Storm

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