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Title: Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems
Authors: Lim, Shir Lynn 
Wang, Kangjie
Lui, Pak Ling
Ramanathan, Kollengode 
Yang, Samantha Peiling
Keywords: thyroid storm
multi-organ failure
extra-corporeal membrane oxygenation
therapeutic plasma exchange
continuous renal replacement therapy
out-of-hospital cardiac arrest
Issue Date: 20-Aug-2021
Citation: Lim, Shir Lynn, Wang, Kangjie, Lui, Pak Ling, Ramanathan, Kollengode, Yang, Samantha Peiling (2021-08-20). Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems. FRONTIERS IN ENDOCRINOLOGY 12. ScholarBank@NUS Repository.
Abstract: Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.
ISSN: 16642392
DOI: 10.3389/fendo.2021.725559
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