Thyrotoxic crisis (
thyroid storm) is a life-threatening condition. Standard
therapy is based on
thiamazole,
prednisolone, and nonselective beta-blockers. Extracorporeal
plasmapheresis is an additional tool for removing circulating
thyroxine in patients who do not respond quickly to conventional standard
therapy. As
thyroxine can be bound by
albumin, the aims of the present
therapy report were to investigate the potential of extracorporeal single-pass
albumin dialysis (
SPAD) to remove
thyroid hormones and to compare it with
plasmapheresis. A 68-year-old female with
thyrotoxic crisis refractory to conventional
therapy underwent two sessions of
plasmapheresis without clinical response. For the treatment dose to be increased, the patient was then treated with a modified
continuous veno-venous hemodialysis with a
dialysate containing 4% of
human serum albumin (
SPAD) intended to bind and remove thyroxines continuously. In total, the patient received three sessions of
plasmapheresis and four
SPAD treatments.
Thyroxine levels were detected in the patient and in exchanged plasma or
albumin dialysate, respectively, to calculate the amount removed. The main finding was that
SPAD treatments were tolerated well by the patient. Due to continuous approach,
SPAD sessions removed more
thyroid hormone than
plasmapheresis did, resulting in the improvement of the clinical status of the patient (reduction of heart rate and
catecholamine dosage), which enabled bridging the patient to
thyroidectomy as the ultimate surgical treatment. This is the first clinical report of the use of
albumin dialysis in
thyroid storm.
SPAD represents a safe and efficient alternative to
plasmapheresis as it can be performed continuously in this critical condition.