{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T10:11:39Z","timestamp":1777111899496,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,6,13]],"date-time":"2017-06-13T00:00:00Z","timestamp":1497312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Thyroid storm is a potentially lethal complication of hyperthyroidism with increased thyroid hormones and exaggerated symptoms of thyrotoxicosis. First\u2010line therapy includes methimazole (MMI) or propylthiouracil (PTU) to block production of thyroid hormones as a bridge toward definitive surgical treatment. Untreated thyroid storm has a mortality rate of up to 30%; this is particularly alarming when patients cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy. Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature. Yet TPE can remove T3 and T4 bound to albumin, autoantibodies, catecholamines and cytokines and is likely beneficial for these patients. We report a patient with thyroid storm who could not tolerate PTU, subsequently failed therapy with MMI, and was not appropriate for thyroidectomy. TPE was therefore performed daily for 4\u00a0days (1.0 plasma volume with 5% albumin replacement and 2\u00a0U of plasma). Over the treatment course, the patient's thyroid hormones normalized and symptoms of thyroid storm largely resolved; his T3 decreased from 2.27 to 0.81\u00a0ng\/mL (normal 0.8\u20102.0), T4 decreased from 4.8 to 1.7\u00a0ng\/mL (0.8\u20101.8), heart rate normalized, altered mental status improved, and he converted to normal sinus rhythm. He was ultimately discharged in euthyroid state. He experienced no side effects from his TPE procedures. TPE is a safe and effective treatment for thyroid storm when conventional treatments are not successful or appropriate.<\/jats:p>","DOI":"10.1002\/jca.21560","type":"journal-article","created":{"date-parts":[[2017,6,13]],"date-time":"2017-06-13T09:36:38Z","timestamp":1497346598000},"page":"113-116","source":"Crossref","is-referenced-by-count":11,"title":["Perfect storm: Therapeutic plasma exchange for a patient with thyroid storm"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-2499","authenticated-orcid":false,"given":"Andrea M.","family":"McGonigle","sequence":"first","affiliation":[{"name":"Transfusion Medicine, Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland"},{"name":"Hemapheresis and Transfusion Support (HATS), Department of Pathology Johns Hopkins Medical Institutions Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron A. R.","family":"Tobian","sequence":"additional","affiliation":[{"name":"Transfusion Medicine, Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland"},{"name":"Hemapheresis and Transfusion Support (HATS), Department of Pathology Johns Hopkins Medical Institutions Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Zink","sequence":"additional","affiliation":[{"name":"Hemapheresis and Transfusion Support (HATS), Department of Pathology Johns Hopkins Medical Institutions Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen E.","family":"King","sequence":"additional","affiliation":[{"name":"Transfusion Medicine, Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland"},{"name":"Hemapheresis and Transfusion Support (HATS), Department of Pathology Johns Hopkins Medical Institutions Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,13]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1177\/0885066613498053","article-title":"Thyroid storm: an updated review","volume":"3","author":"Chiha M","year":"2015","journal-title":"J Intensive Care Med."},{"key":"e_1_2_4_3_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1210\/jc.2014-2850","article-title":"Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study","volume":"100","author":"Angell TE","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200010263431707"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0850"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022933918182"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2006.09.008"},{"key":"e_1_2_4_8_1","doi-asserted-by":"crossref","first-page":"182","DOI":"10.4158\/EP14023.OR","article-title":"Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis","volume":"21","author":"Swee Du S","year":"2015","journal-title":"Endocr Pract."},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2011.01003.x"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01246-3"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198406000-00016"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20161"},{"key":"e_1_2_4_13_1","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1001\/jama.1970.03180070041007","article-title":"Thyroid storm treatment with blood exchange and plasmapheresis","volume":"214","author":"Ashkar FS","year":"1970","journal-title":"JAMA."},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21309"},{"key":"e_1_2_4_15_1","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2012-006696","article-title":"Surviving the storm: two cases of thyroid storm successfully treated with plasmapheresis","author":"Carhill A","year":"2012","journal-title":"BMJ Case Rep."},{"key":"e_1_2_4_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2011.0353"},{"key":"e_1_2_4_17_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.50.6078"},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP09265.CR"},{"key":"e_1_2_4_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20200"},{"key":"e_1_2_4_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1996.00566.x"},{"key":"e_1_2_4_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1368-5031.2004.00140.x"},{"key":"e_1_2_4_22_1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/jca.21470","article-title":"American Society for Apheresis; Apheresis Applications Committee of the American Society for Apheresis. 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