Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure: A case report

Abstract

BACKGROUND

Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis, characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases, such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.

CASE SUMMARY

This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting, diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure. Moreover, she also suffered from heart failure. Therapeutic plasma exchange (commonly known as TPE) and continuous renal replacement therapy (commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.

CONCLUSION

Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Keywords: Severe hyperthyroidism; Propylthiouracil-induced hepatotoxicity; Multiorgan failure; Therapeutic plasma exchange; Continuous renal replacement therapy; Case report

Core tip: Severe hyperthyroidism accompanied with multiple organ failure has been previously reported but is rare. In this case report, acute liver failure like our patient is a very unusual form of presentation. Considering the patient’s medical history, propylthiouracil-induced hepatotoxicity could not be excluded. Therapeutic plasma exchange combined with continuous renal replacement therapy were performed, and successfully stabilized the patient. We suggest that the early application of blood purification technology is feasible in critically patients with severe hyperthyroidism.