title: Role of plasma exchange in the thyroid storm.
abstract: Inadequately treated thyroid storm can lead to death. Therapeutic plasma exchange (TPE) is a suggested treatment when conventional treatments fail, but its indication is not well codified. We report our experience through three explicit cases. Three elderly patients were admitted to our hospital for cardiac or neurologic symptoms due to thyroid storm. After initiation of conventional therapy, TPE was performed with clinical and biological improvement. The speed of symptom resolution varies depending on the severity. This technique must be carried out by experienced medical staff as many complications can occur; nevertheless, in our patients with severe comorbidities, no complications occurred. The action of TPE mainly results from plasma removal of cytokines, putative antibodies, and thyroid hormones and their bound proteins. TPE has a transitory effect and thus should be associated with other thyroid blockers. When there are threatening symptoms, TPE should be done early, without waiting for the efficiency of conventional treatment, since it is the fastest method known for the improvement of the clinical condition. We also suggest starting TPE in case of neurologic symptoms because of very slow and incomplete regression. The Burch and Wartofsky score seems to be a helpful tool in establishing the diagnosis of thyroid storm and for deciding on when to initiate TPE.
authors: Department of Nephrology, Nouvel Hôpital Civil, 1 Place de l’Hôpital, Strasbourg, France. clotilde-muller@hotmail.fr
authors: Clotilde
authors: C
authors: Muller
authors: Peggy
authors: P
authors: Perrin
authors: Bernadette
authors: B
authors: Faller
authors: Sarah
authors: S
authors: Richter
authors: Francois
authors: F
authors: Chantrel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D012720:Severity of Illness Index; D013958:Thyroid Crisis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013963:Thyroid Hormones / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D016207:Cytokines; D013963:Thyroid Hormones