title: Preoperative therapeutic apheresis for severe medically refractory amiodarone-induced thyrotoxicosis: a case report.
abstract: BACKGROUND
  Amiodarone is associated with thyroid dysfunction and life-threatening thyrotoxicosis. In medically refractory cases, or where medical therapy is contraindicated, thyroidectomy may be required. To decrease perioperative thyroid storm and to reduce overall surgical risk, apheresis may be considered preoperatively to restore euthyroidism.
  
  
  METHODS
  We report a 46-year-old female with a history of cardiac arrhythmia and tachycardia-induced cardiomyopathy for which she received amiodarone. Months after discontinuation of amiodarone, the patient presented with wide complex tachycardia and symptoms of thyrotoxicosis. Laboratory testing confirmed severe thyrotoxicosis which was subsequently refractory to medical therapy. Total thyroidectomy was required. Following a total of 10 apheresis treatments, thyroid hormone levels were reduced to near normal levels and the patient's symptoms improved. Thyroidectomy was performed without intraoperative or postoperative complication.
  
  
  CONCLUSIONS
  In the setting of life-threatening, medically refractory amiodarone-induced thyrotoxicosis, therapeutic apheresis can effectively reduce thyroid hormone levels and restore a state of clinical and biochemical euthyroidism.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Hanifa
authors.initials: H
authors.lastname: Dostmohamed
authors.forename: Isanne
authors.initials: I
authors.lastname: Schacter
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ariano
authors.forename: Donald S
authors.initials: DS
authors.lastname: Houston
authors.forename: Brenda
authors.initials: B
authors.lastname: Lewis
authors.forename: Colleen
authors.initials: C
authors.lastname: Knoll
authors.forename: Pamela
authors.initials: P
authors.lastname: Katz
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
mesh_terms: D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001781:Blood Component Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D000889:Anti-Arrhythmia Agents; D014284:Triiodothyronine; D000638:Amiodarone; D013974:Thyroxine
keywords: hyperthyroidism; plasma exchange therapy; thyroidectomy