Thyroid storm with delayed hyperbilirubinemia and severe heart failure: indication and contraindication of plasma exchange
| Autor: | Ken Takeshima, Chiaki Kurimoto, Hiroshi Iwakura, Tomomi Nakao, Hiroyuki Ariyasu, Shuhei Morita, Yasushi Furukawa, Shinsuke Uraki, Takashi Akamizu |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Weight loss Platelet count Hydrocortisone Exacerbation Creatinine (Serum) Endocrinology Diabetes and Metabolism Graves' disease medicine.medical_treatment Red blood cell count Levothyroxine Blood Pressure Kidney Urea and Electrolytes Hyperthyroidism Ultrasound scan lcsh:Diseases of the endocrine glands. Clinical endocrinology Brain Natriuretic Peptide Norepinephrine Beta-blockers 0302 clinical medicine Japan Proptosis White Blood Cell Count Tachycardia Atrial Fibrillation Coughing FT3 Thyroid storm FT4 Tremulousness Fatigue Thyroid September Thyroid Antibodies Goitre Eyelid swelling TSH Lactate dehydrogenase Heart Atrial fibrillation Diarrhoea Thyrotoxicosis 030220 oncology & carcinogenesis Thyroidectomy Cardiology Pyrexia Insight into disease pathogenesis or mechanism of therapy medicine.drug Adult medicine.medical_specialty Thyroxine (T4) Oliguria Heart failure 030209 endocrinology & metabolism Urinalysis Chloride X-ray 03 medical and health sciences Internal medicine Dyspnoea Alkaline phosphatase Internal Medicine medicine Glucocorticoids Contraindication Methimazole Potassium iodide lcsh:RC648-665 Triiodothyronine (T3) business.industry Asian - Japanese Albumin Sodium Bilirubin Alanine Aminotransferase Conjunctivitis medicine.disease Electrocardiogram Oedema Potassium business Dialysis |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-5 (2020) Endocrinology, Diabetes & Metabolism Case Reports |
| ISSN: | 2052-0573 |
| Popis: | Summary Thyroid storm (TS) is a life-threatening condition that may suffer thyrotoxic patients. Therapeutic plasma exchange (TPE) is a rescue approach for TS with acute hepatic failure, but it should be initiated with careful considerations. We present a 55-year-old male patient with untreated Graves’ disease who developed TS. Severe hyperthyroidism and refractory atrial fibrillation with congestive heart failure aggregated to multiple organ failure. The patient was recovered by intensive multimodal therapy, but we had difficulty in introducing TPE treatment considering the risk of exacerbation of congestive heart failure due to plasma volume overload. In addition, serum total bilirubin level was not elevated in the early phase to the level of indication for TPE. The clinical course of this patient instructed delayed elevation of bilirubin until the level of indication for TPE in some patients and also demonstrated the risk of exacerbation of congestive heart failure by TPE. Learning points: Our patient with thyroid storm could be diagnosed and treated promptly using Japan Thyroid Association guidelines for thyroid storm. Delayed elevation of serum bilirubin levels could make the decision of introducing therapeutic plasma exchange difficult in cases of thyroid storm with acute hepatic failure. The risk of worsening congestive heart failure should be considered carefully when performing therapeutic plasma exchange. |
| Databáze: | OpenAIRE |
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