scholarly journals Thyroid storm with delayed hyperbilirubinemia and severe heart failure: indication and contraindication of plasma exchange

2020 ◽  
Vol 2020 ◽  
Author(s):  
Tomomi Nakao ◽  
Ken Takeshima ◽  
Hiroyuki Ariyasu ◽  
Chiaki Kurimoto ◽  
Shinsuke Uraki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Plasma Exchange ◽  
Hepatic Failure ◽  
Severe Heart Failure ◽  
Acute Hepatic Failure ◽  
Therapeutic Plasma Exchange ◽  
Thyroid Storm ◽  
Serum Total Bilirubin ◽  
List Type

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.

Fulminante intrakardiale Thrombose bei Budd-Chiari-Syndrom und Thrombose der Vena cava inferior

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 62-65 ◽  
Author(s):  
F. Eckel ◽  
Huber ◽  
Heidecke ◽  
Moessmer ◽  
Berger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hepatic Failure ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Acute Hepatic Failure ◽  
Hepatic Veins ◽  
Factor V ◽  
Recombinant Hirudin ◽  
The Right

The most common cause of edema of the legs and dyspnea is congestive heart failure. Further differential diagnosis such as renal or hepatic failure have to be considered. We report the case of a previous healthy 65-year-old woman who developed dyspnea and massive edema of the legs followed by acute hepatic and renal failure. Imaging studies showed a thrombosis of the inferior vena cava (IVC) caused by a tumor between the right kidney and the IVC. Histological examination revealed a leiomyosarcoma of the IVC. Hepatic failure due to venous outflow obstruction (Budd-Chiari syndrome, BCS) was diagnosed. Coagulation profile showed a complex disorder due to acute hepatic failure. Factor V Leiden and prothrombin gene mutation G20210A could be excluded. The thrombosis extended from the femoral veins up to the right atrium. After 11 days of anticoagulation with heparin platelet counts decreased by more than 50%. Suspecting a heparin-induced thrombocytopenia the patient was placed on recombinant hirudin (lepirudin) for anticoagulation. Hepatic venogram showed a thrombosis of the hepatic vein orifices but not of the hepatic veins. The tumor and the thrombi were removed surgically. When the cardiopulmonary bypass was terminated new intracardiac thrombi occurred. Despite immediate surgical intervention the patient finally died due to right ventricular failure cuased by the fulminate intracardiac thrombosis. In conclusion, thrombosis of the IVC may mimic congestive heart failure and may cause BCS. Neoplasms and coagulation disorders may cause thrombosis of the IVC.

scholarly journals Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm

2019 ◽  
Vol 2019 ◽  
Author(s):  
Yuri Tanaka ◽  
Taisuke Uchida ◽  
Hideki Yamaguchi ◽  
Yohei Kudo ◽  
Tadato Yonekawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Transplantation ◽  
Plasma Exchange ◽  
Fulminant Hepatitis ◽  
Poor Prognosis ◽  
Interleukin 2 ◽  
Thyroid Storm ◽  
List Type ◽  
Interleukin 2 Receptor ◽  
Soluble Interleukin 2 Receptor

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.

scholarly journals Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure

2020 ◽  
Vol 24 (5) ◽  
pp. 361-362
Author(s):  
Devki Nandan ◽  
Dhirendra P Singh ◽  
Sheetal Agarwal ◽  
Ruby Singh ◽  
Anubhav Gupta
Keyword(s):  
Plasma Exchange ◽  
Hepatic Failure ◽  
Parvovirus B19 ◽  
Acute Hepatic Failure ◽  
Therapeutic Plasma Exchange

Ivabradine for Uncontrolled Sinus Tachycardia in Thyrotoxic Cardiomyopathy – Case Report

2021 ◽  
Vol 21 ◽  
Author(s):  
Amit Frenkel ◽  
Yoav Bichovsky ◽  
Natan Arotsker ◽  
Limor Besser ◽  
Ben-Zion Joshua ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Congestive Heart Failure ◽  
Sinus Tachycardia ◽  
Beta Blockers ◽  
Selective Inhibitor ◽  
Thyroid Storm ◽  
Case Presentation ◽  
Control Heart ◽  
Control Heart Rate

Background: Beta blockers, mainly propranalol, are usually administered to control heart rate in patients with thyrotoxicosis, especially when congestive heart failure presents. However, when thyrotoxicosis is not controlled, heart rate may be difficult to control even with maximal doses of propranolol. This presentation alerts physicians to the possibility of using ivabradine, a selective inhibitor of the sinoatrial pacemaker, for the control of heart rate. Case presentation: We present a 37-year-old woman with thyrotoxicosis and congestive heart failure whose heart rate was not controlled with a maximal dose of beta blockers during a thyroid storm. The addition of ivabradine, a selective inhibitor of the sinoatrial pacemaker, controlled her heart rate within 48 hours. Conclusion: Ivabradine should be considered in patients with thyrotoxicosis, including those with heart failure, in whom beta blockers are insufficient to control heart rate

Sign in / Sign up

Export Citation Format

Share Document