Therapeutic Plasma Exchange Combined with Total Thyroidectomy to Rescue a Case of Thyroid Storm Intolerant to Antithyroid Drugs

Thyroid storm is a syndrome related to acute exacerbation of thyrotoxicosis for which timely diagnosis and treatment are crucial. Importance of antithyroid drug therapy in thyroid storm patients has been emphasised in clinical treatments for a long time. These patients should receive definitive therapy for their underlying hyperthyroidism to avoid recurrence after controlling thyroid storm. However, the curative effect of antithyroid medication is sometimes limited because of rare or serious side effects or failure to control disease progression, resulting in few treatment alternatives. We present a case of an old woman with thyroid storm and antithyroid drug intolerance, which was successfully managed using a combination of plasma exchange and thyroidectomy. It confirms the significant benefits of therapeutic plasma exchange (TPE) when clinical conditions do not allow routine treatment of thyroid storm. This procedure is safe and effective when performed preoperatively as a rescue measure for thyroid storm patients. Key Words: Thyroid storm, Drug intolerance, Plasma exchange, Total Thyroidectomy.