العاصفة الدرقية التي لا تستجيب للعلاج الأولي متعدد الأساليب: ماذا تفعل بعد ذلك

References

1. Therapeutic plasmapheresis (TPE) should be considered if clinical improvement is not noted within 24–48 hours of initial treatment with appropriate doses of ATDs, inorganic iodine, corticosteroids, or beta-AAs, as well as specific treatment for the triggering disease and complications with thyroid storm.
2. Therefore, it is recommended that FFP be used as the replacement solution in TPE to treat thyroid storm because FFP is expected to reduce thyroid hormones more efficiently than albumin solution.
3. This study recommended that TPE should be performed daily with 40–50 mL/kg of replacement solution until clinical improvements are noted, and FT3 and FT4 levels should be sampled before and after each session.
4. Since CHDF is performed not only for the treatment of acute hepatic and renal failure, but also for the removal of excess cytokines in systemic inflammatory response syndrome (SIRS), the combined use of TPE with CHDF is recommended for patients with severe complications such as multiple organ failure.
5. TPE should not be dis-continued if there is no reduction in FT3 or FT4 levels because of biologico-clinical dissociation.