Amiodarone induced thyrotoxicosis may not respond to therapeutic plasma exchange like patients with graves’ disease: A report of two cases and literature review

The achievement of euthyroid state has been suggested in patients with thyrotoxicosis undergoing surgery to reduce the risk of thyroid storm. However, euthyroid state could not always be achieved by antithyroid drugs. Therefore, therapeutic plasma exchange (TPE) is an option in this condition. A 58-year-old male patient with a history of type-2 diabetes using 200 mg amiodarone per day, admitted for diabetic ketoacidosis (DKA), induced by thyrotoxicosis. with palpitation, sweating, polyuria, and polydipsia. Euthyroid state could not be achieved, despite all apropriate treatments for thyrotoxicosis. Therefore, preparation with TPE followed by total thyroidectomy was planned. A 35% decrease in fT3 (free T3) and fT4 (free T4) levels were achieved, after two sessions of TPE. A 74-year-old male patient, admitted for acute anterior myocardial infarction (AMI) induced by thyrotoxicosis due to Graves’ disease. Multiple vessel disease was detected on primer percutanous coronary angiography, and an emergency coronary artery bypass grafting (CABG) was planned. Therefore, preperation with TPE was planned before surgery. A substential decrease in fT4 and fT3 levels (45% and 72%, respectively) levels were achieved, after one session of TPE. Most of the studies evaluating the efficacy of TPE in patients with thyrotoxicosis are including patients with Graves’ disease and toxic multinodular goiter, and TPE was indicated as an effective option for preparation of these patients for surgery. However, as presented in case 1, TPE may not be effective in amiodarone induced thyrotoxicosis (AIT) as in cases with thyrotoxicosis due to Graves’ disease.

Kaynakça

Braverman L, Utiger R. Introduction to thyrotoxicosis. In: Braverman L, Utiger R eds. The Thyroid. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2005;453-5.

Bahn Chair RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis. Management guidelines of the American thyroid association and American association of clinical endocrinologists. Thyroid. 2011;21:593-646.

Goldschlager N, Epstein AE, Naccarelli G, et al. Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med. 2000;26;160:1741-8.

Kennedy RL, Griffiths H, Gray TA. Amiodarone and the thyroid. Clin Chem. 1989;35:1882-7.

Newman CM, Price A, Davies DW, et al. Amiodarone and the thyroid: A practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart. 1998;79:121-7.

Fischli S, Lucchini B, Müller W, et al. Rapid preoperative blockage of thyroid hormone production / secretion in patients with Graves’ disease. Swiss Med Wkly. 2016;14;146:14243.

Restrepo CA, Márquez E, Sanz MF. Plasmaféresis terapéutica, tipos, técnica e indicaciones en medicina interna. Acta Med Colomb. 2009;34:23-32.

Baeza A, Aguayo J, Barria M, Pineda G. Rapid preoperative preparation in hyperthyroidism. Clin Endocrinol. 1991;35:439-42.

Scholz GH, Hagemann E, Arkenau C, et al. Is there a place for thyroidectomy in older patients with thyrotoxic storm and cardiorespiratory failure? Thyroid. 2003;13:933-40.

Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange complica¬tions and management. Am J Kidney Dis. 1994;23:817-27.

Zhu L, Zainudin SB, Kaushik M, et al. Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis. Endocrinol Diabetes Metab Case Rep. 2016;160039.

Simsir IY, Ozdemir M, Duman S, et al. Therapeutic plasmapheresis in thyrotoxic patients. Endocrine. 2018;62:144-8.

Guzmán GE, Bautista DF, Arango LG, et al. Therapeutic plasmapheresis in patients with thyrotoxicosis. Report of Two Cases. Rheumatology. 2015;5:162.

Kaynak Göster

Medicine Science
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012

13.5b7.4b

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