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Preoperative therapeutic apheresis for severe medically refractory amiodarone‐induced thyrotoxicosis: A case report
Author(s) -
Yamamoto Jennifer,
Dostmohamed Hanifa,
Schacter Isanne,
Ariano Robert E.,
Houston Donald S.,
Lewis Brenda,
Knoll Colleen,
Katz Pamela,
Zarychanski Ryan
Publication year - 2014
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21309
Subject(s) - medicine , amiodarone , thyroid storm , refractory (planetary science) , discontinuation , apheresis , thyroidectomy , tachycardia , thyroid , surgery , complication , perioperative , atrial fibrillation , anesthesia , platelet , physics , astrobiology
: Amiodarone is associated with thyroid dysfunction and life‐threatening thyrotoxicosis. In medically refractory cases, or where medical therapy is contraindicated, thyroidectomy may be required. To decrease perioperative thyroid storm and to reduce overall surgical risk, apheresis may be considered preoperatively to restore euthyroidism. Case Description : We report a 46‐year‐old female with a history of cardiac arrhythmia and tachycardia‐induced cardiomyopathy for which she received amiodarone. Months after discontinuation of amiodarone, the patient presented with wide complex tachycardia and symptoms of thyrotoxicosis. Laboratory testing confirmed severe thyrotoxicosis which was subsequently refractory to medical therapy. Total thyroidectomy was required. Following a total of 10 apheresis treatments, thyroid hormone levels were reduced to near normal levels and the patient's symptoms improved. Thyroidectomy was performed without intraoperative or postoperative complication. Discussion : In the setting of life‐threatening, medically refractory amiodarone‐induced thyrotoxicosis, therapeutic apheresis can effectively reduce thyroid hormone levels and restore a state of clinical and biochemical euthyroidism. J. Clin. Apheresis 29:168–170, 2014. © 2013 Wiley Periodicals, Inc.