The effect of plasma exchange on the patient with multiple organ failure due to severe thyroid crisis and cardiopulmonary resuscitation

Abstract

A 50 year-old woman who perspires heavily for three years was admitted for severe edema, serous diarrhea and dyspnea. Blood test and X-ray scanning revealed severe hyperthyroidism and cardiac enlargement with massive pleural effusion. We diagnosed thyroidal crisis. She became the cardiopulmonary arrest during clinical examination, we started cardiopulmonary resuscitation immediately. Her heart beat recovered quickly but her hemodynamics did not recover. We treated her with intra-aortic balloon pumping and percutaneous cardio pulmonary support, however, blood pressure (BP) still showed very low level. We started plasma exchange (PE) and continuous hemodiafiltration in order to remove excessive thyroid hormones. The serum levels of thyroid hormones decreased and systemic vascular resistance index and BP increased significantly during the first session of PE. PE has a remarkable effect on the removal of thyroid hormones in patient with severe thyroid crisis.