Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1184-1190
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1184
Therapeutic plasma exchange and a double plasma molecular absorption system in the treatment of thyroid storm with severe liver injury: A case report
You-Wen Tan, Li Sun, Kai Zhang, Li Zhu
You-Wen Tan, Li Sun, Kai Zhang, Li Zhu, Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
Author contributions: Tan YW and Sun L contributed equally to this work; Tan YW and Sun L designed the research; Zhang K and Sun L collected and analyzed the data, and drafted the manuscript; Zhu L performed therapeutic plasma exchange and double plasma molecular absorption system; Tan YW wrote and revised the manuscript; all authors have read and approved the final version to be published.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: We are committed to writing in CARE Checklist (2016) format.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: You-Wen Tan, MD, PhD, Chief Doctor, Department of Hepatosis, the Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, Jiangsu Province, China. tyw915@sina.com
Telephone: +86-511-88970796 Fax: +86-511-88970796
Received: January 13, 2019
Peer-review started: January 13, 2019
First decision: January 26, 2019
Revised: January 29, 2019
Accepted: March 8, 2019
Article in press: March 9, 2019
Published online: May 26, 2019
Processing time: 135 Days and 1.9 Hours
Abstract
BACKGROUND

Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means. Plasma exchange (PE) and double plasma molecular absorption system (DPMAS) can be used as an effective treatment for thyroid storm with severe liver injury.

CASE SUMMARY

A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa. Further, her free T3 (FT3) and FT4 levels were significantly elevated, whereas her thyrotropin level was reduced. After admission, her condition continued to deteriorate, and she presented with continued high fever, vomiting, palpitation, and shortness of breath. After being diagnosed with thyroid storm, the patient was immediately treated with PE combined with DPMAS. Her symptoms improved immediately. After three PE + DPMAS treatments, and she was discharged from the hospital. She was treated with methylprednisolone and methylthimidazole. After six months, the patient spontaneously discontinued methylthimidazole treatment. Her previous clinical manifestations and liver dysfunction reoccurred. The patient was treated with PE + DPMAS two times, and her condition rapidly improved. Liver histopathology indicated immunological liver injury.

CONCLUSION

Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.

Keywords: Plasma exchange; Thyroid storm; Immunological liver injury; Case report

Core tip: Plasma exchange (PE) and double plasma molecular absorption system (DPMAS) can be used as an effective treatment for thyroid storm with severe liver injury. A 52-year-old woman presented with a 10-d history of nausea and vomiting accompanied by yellowing of the skin and mucosa. After being diagnosed with thyroid storm accompanied by severe liver injury, the patient was immediately treated with PE combined with DPMAS for three times and discharged from the hospital. After six months, her previous clinical manifestations and liver dysfunction reoccurred and treated with PE + DPMAS again, her condition rapidly improved and liver histopathology indicated immunological liver injury.