Endocrine Abstracts

Introduction: A thyroid storm (TS) (or thyrotoxic crisis) is a rare, acute, life-threatening endocrine emergency characterized by severe clinical manifestations of thyrotoxicosis. The mortality rate is between 10 and 30%. So this condition must be quickly identified and treated by clinicians. Plasma exchange(PE) has been used as a treatment option for thyroid storms. However, to date, there have been only a few studies assessing the effect of PE with varying results.

Case Report: A 50-year-old female patient was admitted to the emergency department due to dyspnea, chest pain, and palpitations. It was learned that the patient, who had been diagnosed with hyperthyroidism for 10 years, had stopped using methimazole for 1 month. On admission, the patient’s heart rate was 147. Atrial fibrillation (AF) was detected on the ECG. Echocardiography revealed EF:25-30%, global hypokinesia. The patient with TSH <0,005(0,31-4,49 mıU/l), fT4:7.77(0,85-1,70 ng/dl) fT3:11.5 (2,04-4,4 ng/l) was evaluated as thyroid storm. She was monitored in the intensive care unit. Hydrocortisone 300 mg, propylthiouracil 3*300 mg and propronolol 2*20 mg were started. Since there was not enough decrease in fT3 and fT4 levels, 3*5 drops of potassium iodide were added to the treatment. Thyroid otoanticors detected high levels. Thyroid ultrasound showed heterogeneity and focal abnormalities in the thyroid parenchyma nodüles were detected. During follow-up, hydrocortisone was switched to methylprednisolone, and propylthiouracil was switched to methimazole. In the consultation with the general surgeon, a thyroidectomy was planned to be performed after plasmapheresis for the patient who did not have a sufficient decrease in fT3 and fT4. The patient underwent plasmapheresis for 3 days. After plasmapheresis fT3 decreased from 5,27 to 4,1 and fT4 decreased from 2,96 to 2,4. Thyroidectomy was performed. Control echocardiography EF was seen as 50-55% and the peak HR was between 70-80. Ft3:0,4 fT4:0,26 was observed and levothyroxine was started. Cardiology planned to perform cardioversion on the patient whose AF rhythm continued was planned to continue outpatient follow-up with cardiology.

Conclusion: PE is a treatment option for thyroid storm. However, the effect of PE has not been accurately assessed yet. So we think that more case reports are needed.