Abstract
Thyroid crisis is a rare life-threatening disorder and its prompt treatment is essential to a complete recovery. We describe a patient with thyroid crisis precipitated by thyroid surgery who survived despite developing multiple organ failure. A 37-year-old woman with Graves' s disease was operated on for long-standing uncontrolled hyperthyroidism. Preoperative examination revealed a marked increase in thyroid hormone levels (FT4 8.82 ng/dL, FT3>30 pg/mL). Total thyroidectomy was uneventfully performed under general anesthesia with carperitide and landiolol given during the operation. On the 1st postoperative day (POD), she developed thyroid crisis characterized by high fever, heart failure and altered mentation, finally leading to cardiac arrest. After successful restoration of sinus rhythm, we progressively started an intensive therapy for hyperthyroidism, congestive heart failure, renal failure, hepatic dysfunction and disseminated intravascular coagulation, but no significant improvement was seen in her condition. On the 2nd POD, her cardiohemodynamics were surprisingly improved by plasma exchange using 40 units of fresh frozen plasma. She gradually recovered from her multiple organ failure and left ICU on the 19th POD. When clinical deterioration occurs despite medical management directed against thyroid crisis after thyroidectomy, plasma exchange may be a useful therapeutic option.
