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Endocrine Abstracts (2015) 37 GP27.07 | DOI: 10.1530/endoabs.37.GP.27.07

1Hospital Garcia de Orta–Endocrinologia e Diabetes, Almada, Portugal; 2Hospital Garcia de Orta–Nefrologia, Almada, Portugal.

Thyroid storm (TS) is one extreme of a continuum beginning with thyrotoxicosis. It’s rarely caused by exogenous thyroid hormone intake (ETHI). Aggressive medical therapy is the cornerstone of treatment; nevertheless, it might not be sufficient. Plasmapheresis is an extracorporeal technique that can rapidly lower thyroid hormone levels. The aim of this study was to assess the efficacy of plasmapheresis in TS secondary to ETHI. We evaluated retrospectively all TS cases (Burch–Wartofsky score >45) caused by ETHI, treated with plasmapheresis between 1991 and 2014 in a tertiary hospital. Patient clinical data, normal thyroglobulin and negative anti-thyroglobulin antibodies ruled out endogenous causes. Statistical analysis was performed with Wilcoxon’s test (SPSS v.21).

Five cases were recorded. The median age was 45 years and four patients were female. The Burch–Wartofsky score ranged from 50 to 85. All patients presented with delirium, the median heart rate was 134 b.p.m. and four patients required an intensive care unit because of hemodynamic instability. Standard medical therapy for TS was initiated on admission. Plasmapheresis sessions ranged from 3 to 4 and were started between days 2 and 5 after admission. Before the first plasmapheresis, median TT4 was 70 μg/dl (4.5–12.5), FT4 17.2 ng/dl (0.8–1.5), TT3 1800 ng/dl (80–200), and FT3 46 pg/ml (1.5–5). The first session induced a significant decrease in median TT4 and FT4 levels of 40 and 46% respectively (P=0.043). After the last session, a significant large decrease in all thyroid hormone levels was observed: TT4 – 75%, FT4 – 72%, TT3 – 92%, and FT3 – 85%. (Z=−2.023, P=0.043, r=0.64). Euthyroidism was achieved after a median of 12 days.

Our study showed that plasmapheresis induced a significant and rapid decrease in hormone levels, allowing all the patients to recover. It should be considered as a second line therapy for refractory TS induced by ETHI and should be started relatively soon in the treatment algorithm.

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