Therapeutic plasma exchange (TPE) may be useful in the management of a patient with thyroid storm as a temporary solution until more definitive therapy can be used.
Indication: complicated thyroid storm/crisis. The patient may have multi-organ failure or have hemodynamic instability.
Goal: rapid reduction in circulating thyroid hormones
It may be attempted when alternative therapies are unsafe or have failed to control thyroid hormone production.
Effect:
(1) removes free and protein-bound hormone, thyroid autoantibodies, cytokines and catecholamines
(2) provides unsaturated binding sites for thyroid hormone
Usually multiple sessions are required.
Once the patient is stabilized then thyroidectomy may be performed or radioactive iodine can be administered.
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