Rescue Plasma Exchange in Thyroid Storm: Successful Bridging to Thionamide Therapy
https://doi.org/10.15605/jafes.041.S1
- Author:
Pei Sun Tan
1
;
Hafizah Mohd Amadzun
1
;
Sharifah Noor Adrilla Long Mohd Noor Affendi
1
;
Gayathri Devi Krishnan
1
;
Shazatul Reza binti Mohd Redzuan
1
;
Subashini Rajoo
1
Author Information
1. Endocrine Unit, Department of Internal Medicine, Hospital Kuala Lumpur
- Publication Type:Journal Article
- MeSH:
Plasma Exchange;
Thyroid Crisis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):122-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Therapeutic plasma exchange (TPE) has emerged as a
rescue therapy in thyroid storm. Multiple cycles are often
required to achieve adequate reduction in circulating
thyroid hormone levels. We report a case of thyroid storm
with multiorgan failure successfully managed with only
two cycles of TPE, followed by carbimazole.
A 43-year-old female with no significant past medical
history presented with a 5-month history of altered bowel
habits. She has a small goiter, which was not investigated
before. She underwent elective esophagogastroduodenoscopy and colonoscopy at a private centre, both of which
were unremarkable. Post-procedure, she developed
unstable tachyarrhythmia and cardiac arrest. Return of
spontaneous circulation was achieved after three cycles of
cardiopulmonary resuscitation, and she was transferred
to the intensive care unit. Biochemical evaluation revealed
severe thyrotoxicosis (thyroid-stimulating hormone [TSH]
<0.008 mIU/L, free thyroxine 4 [FT4] >100 pmol/L). BurchWartofsky Point Scale was 90. Her clinical course was complicated by multiorgan failure,
including ischemic hepatitis with coagulopathy and
oliguric acute kidney injury requiring continuous venovenous hemodialysis. Lugol’s iodine and corticosteroids
were initiated as thionamides were contraindicated due
to severe hepatic dysfunction. She developed refractory
tachyarrhythmia despite electrical cardioversion. Following
a multidisciplinary discussion, TPE was initiated due to the
limited choice of antithyroid medication.
After two TPE sessions, thyroid function improved
markedly (TSH 0.01 mIU/L, FT4 26.2 pmol/L), accompanied
by improvement in hepatic and renal function, allowing
safe commencement of carbimazole. Thyroid function
remained stable with FT4 of 19.3 pmol/L 1 week post
TPE. Echocardiography demonstrated mildly reduced
left ventricular ejection fraction (45–50%) with bi-atrial
dilatation.
Conclusion:This case highlights the role of limited-cycle TPE as an
effective rescue therapy and bridging strategy to definitive
treatment in severe thyroid storm with multiorgan failure.
Timely TPE initiation may improve biochemical control
and clinical outcomes in critically ill patients.
- Full text:2026080510060799872EP_A183.pdf
