Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Medication

You are looking at 1 - 2 of 2 items for :

  • Methimazole x
  • Potassium iodide x
Clear All
Tomomi Nakao First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Tomomi Nakao in
Google Scholar
PubMed Close
,
Ken Takeshima First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Ken Takeshima in
Google Scholar
PubMed Close
,
Hiroyuki Ariyasu First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Hiroyuki Ariyasu in
Google Scholar
PubMed Close
,
Chiaki Kurimoto First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Chiaki Kurimoto in
Google Scholar
PubMed Close
,
Shinsuke Uraki First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Shinsuke Uraki in
Google Scholar
PubMed Close
,
Shuhei Morita First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Shuhei Morita in
Google Scholar
PubMed Close
,
Yasushi Furukawa First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Yasushi Furukawa in
Google Scholar
PubMed Close
,
Hiroshi Iwakura First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Hiroshi Iwakura in
Google Scholar
PubMed Close
, and
Takashi Akamizu First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan

Search for other papers by Takashi Akamizu in
Google Scholar
PubMed Close

Summary

Thyroid storm (TS) is a life-threatening condition that may suffer thyrotoxic patients. Therapeutic plasma exchange (TPE) is a rescue approach for TS with acute hepatic failure, but it should be initiated with careful considerations. We present a 55-year-old male patient with untreated Graves’ disease who developed TS. Severe hyperthyroidism and refractory atrial fibrillation with congestive heart failure aggregated to multiple organ failure. The patient was recovered by intensive multimodal therapy, but we had difficulty in introducing TPE treatment considering the risk of exacerbation of congestive heart failure due to plasma volume overload. In addition, serum total bilirubin level was not elevated in the early phase to the level of indication for TPE. The clinical course of this patient instructed delayed elevation of bilirubin until the level of indication for TPE in some patients and also demonstrated the risk of exacerbation of congestive heart failure by TPE.

Learning points:

  • Our patient with thyroid storm could be diagnosed and treated promptly using Japan Thyroid Association guidelines for thyroid storm.

  • Delayed elevation of serum bilirubin levels could make the decision of introducing therapeutic plasma exchange difficult in cases of thyroid storm with acute hepatic failure.

  • The risk of worsening congestive heart failure should be considered carefully when performing therapeutic plasma exchange.

Taxonomy:
Clinical Overview, Gland/Organ, Heart, Kidney, Thyroid, Topic, Thyroid, Hormone, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Graves' disease, Hyperthyroidism, Thyroid storm, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, Asian - Japanese, Country of Treatment, Japan, Diagnosis and Treatment, Signs and Symptoms, Atrial fibrillation, Conjunctivitis, Coughing, Diarrhoea, Dyspnoea, Eyelid swelling, Fatigue, Goitre, Heart failure, Hyperthyroidism, Oedema, Oliguria, Proptosis, Pyrexia, Tachycardia, Thyrotoxicosis, Tremulousness, Weight loss, Investigation, Alanine aminotransferase, Albumin, Alkaline phosphatase, Bilirubin, Blood pressure, Brain natriuretic peptide, Chloride, Creatinine (serum), Electrocardiogram, FT3, FT4, Lactate dehydrogenase, Platelet count, Potassium, Red blood cell count, Sodium, Thyroid antibodies, TSH, Ultrasound scan, Urea and electrolytes, Urinalysis, White blood cell count, X-ray, Intervention, Dialysis, Thyroidectomy, Medication, Beta-blockers, Glucocorticoids, Hydrocortisone, Levothyroxine, Methimazole, Norepinephrine, Potassium iodide, Publication Details, Case Report Type, Insight into disease pathogenesis or mechanism of therapy
DOI:
https://doi.org/10.1530/EDM-20-0036
Volume/Issue:
Volume 2020: Issue 1
Open access
Yuri Tanaka Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Yuri Tanaka in
Google Scholar
PubMed Close
,
Taisuke Uchida Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Taisuke Uchida in
Google Scholar
PubMed Close
,
Hideki Yamaguchi Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Hideki Yamaguchi in
Google Scholar
PubMed Close
,
Yohei Kudo Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Yohei Kudo in
Google Scholar
PubMed Close
,
Tadato Yonekawa Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Tadato Yonekawa in
Google Scholar
PubMed Close
, and
Masamitsu Nakazato Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

Search for other papers by Masamitsu Nakazato in
Google Scholar
PubMed Close

Summary

We report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves’ disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis.

Learning points:

  • The prognosis of thyroid storm when fulminant hepatitis occurs is poor.

  • Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange.

  • Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.

Taxonomy:
Clinical Overview, Gland/Organ, Heart, Liver, Thyroid, Hormone, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Graves' disease, Liver failure, Thyroid storm, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, Asian - Japanese, Country of Treatment, Japan, Diagnosis and Treatment, Signs and Symptoms, Atrial fibrillation, Breathing difficulties, Cardiogenic shock, Cardiomegaly, Coagulopathy, Dyspnoea, Fatigue, Goitre, Heart failure, Hyperhidrosis, Hyperthyroidism, Hypoglycaemia, Hypoxia, Jaundice, Metabolic acidosis, Oedema, Pyrexia, Renal failure, Tachycardia, Weight loss, Investigation, Alanine aminotransferase, Albumin, Alkaline phosphatase, Ammonia, Bilirubin, Brain natriuretic peptide, Calcium (serum), C-reactive protein, Creatinine, CT scan, Echocardiogram, FT3, FT4, Glucose (blood), Lactate dehydrogenase, Potassium, Thyroid antibodies, Transaminase, TSH, X-ray, Intervention, Dialysis, Plasma exchange, Medication, Beta-blockers, Glucocorticoids, Glucose, Hydrocortisone, Methimazole, Potassium iodide, Propylthiouracil, Related Disciplines, Cardiology, Gastroenterology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-19-0078
Volume/Issue:
Volume 2019: Issue 1
Open access