SUN-497 Life-Saving Management of Thyrotoxicosis with a Single Session of Plasmapheresis

Abstract

Thyroid hormones are essential in controlling numerous metabolic and regulatory processes in the human body. Thyroid storm is a medical emergency and is the most extreme manifestation of the overproduction of thyroid hormones. It is critical to recognize thyroid storm at its earliest state and conventional practice recommends initiating treatment immediately with steroids, thionamides, and beta-blockers.Here we present a case of a patient with Graves’ disease in which thionamides could not be continued due to acute thionamide-induced hepatotoxicity. With the patient’s worsening thyrotoxic state, declining mental status and clinical deterioration; the decision was made to initiate plasmapheresis as a life-saving therapy to remove the thyroid stimulating antibodies responsible for the patient’s deteriorating status.After one session of plasmapheresis, the patients’ clinical condition began to significantly improve to baseline, along with normalization of his thyroid function and the patient was discharged home with plans for emergent thyroidectomy.This case demonstrates the importance of considering plasmapheresis as a life saving measure in the treatment algorithm of patients with extreme thyrotoxicosis and thyroid storm in which traditional therapies such as thionamides, steroids, and beta-blockers cannot be used or are ineffective. Reference:Ono, Y., Ono, S., Yasunaga, H., Matsui, H., Fushimi, K., & Tanaka, Y. (2016, February 18). Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Retrieved April 6, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998648/