E-Poster Presentation ESA-SRB-ANZBMS 2021

Plasmapheresis as a bridge to urgent thyroidectomy in a patient with Type 2 Amiodarone Induced Thyrotoxicosis: A case report and review of literature. (#409)

Manik J Mayadunne 1 2 , Ruwanthi Wijayawardana 3 , Elizabeth Newman 4 , Emma Verner 5 , Kirtan Ganda 1 2 , Erick Fuentes 3
  1. Endocrinology, Concord Repatriation General Hospital, Concord, NSW, Australia
  2. University of Sydney, Sydney, NSW, Australia
  3. Breast and endocrine surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
  4. Apheresis, Concord Repatriation General Hospital, Concord, NSW, Australia
  5. Haematology, Concord Repatriation General Hospital, Concord, NSW, Australia

Type 2 amiodarone-induced thyrotoxicosis (AIT2) is a result of destructive thyroiditis and systemic release of thyroid hormones.1 In AIT2, corticosteroid therapy is recommended, however thionamides and Lugol’s iodide are ineffective.2,3 In those who have contraindications to steroids and/or require rapid reduction in thryoid hormone levels, plasmapheresis may be an option.3,4 We herein report a case of AIT2 in a 68-year-old man who required rapid and urgent control of his thyroid state to allow a partial hepatectomy to be safely performed to remove a hepatocellular carcinoma with radiological features suggestive of a high risk of rupture. Corticosteroids were relatively contraindicated in the perioperative setting. Therefore, total thyroidectomy was determined to be the most appropriate and definitive therapy to normalise his thyroid function in anticipation of hepatic resection. To achieve a rapid reduction in circulating thyroid hormones, plasmapheresis was successfully utilised as a bridge to thyroidectomy. A hemi-hepatectomy subsequently followed, without significant complications. Therefore, this case illustrates the utilitisation of plasmapheresis in a patient with severe thyrotoxicosis due to AIT2 preceding thyroidectomy. Features of this case are discussed, together with its implications, and a review of the relevant literature.

  1. Enio Martino, Luigi Bartalena, Fausto Bogazzi, Lewis E. Braverman, The Effects of Amiodarone on the Thyroid, Endocrine Reviews, Volume 22, Issue 2, 1 April 2001, Pages 240–254
  2. Silvia A. Eskes, Erik Endert, Eric Fliers, Ronald B. Geskus, Robin P. F. Dullaart, Thera P. Links, Wilmar M. Wiersinga, Treatment of Amiodarone-Induced Thyrotoxicosis Type 2: A Randomized Clinical Trial, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 2, 1 February 2012, Pages 499–506.
  3. Zhu, L., Zainudin, S. B., Kaushik, M., Khor, L. Y., & Chng, C. L. (2016). Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis, Endocrinology, Diabetes & Metabolism Case Reports, 2016, 16-0039.
  4. Simsir, I.Y., Ozdemir, M., Duman, S. et al. Therapeutic plasmapheresis in thyrotoxic patients. Endocrine 62, 144–148 (2018).