Treatment of Severe Thyrotoxicosis With Therapeutic Plasma Exchange in a Patient With a Methimazole Adverse Reaction

Recent research indicates that therapeutic plasma exchange (TPE) has been successfully used in the treatment of thyrotoxicosis in patients where conventional treatment measures failed to effectively control severe thyrotoxicosis, also known as thyroid storm. We present the case of a woman in her late 70s with a history of atrial fibrillation (AFib), hypertension, hyperthyroidism, and anxiety, who presented to the hospital following a hemorrhagic stroke and myocardial infarction that subsequently developed severe thyrotoxicosis following the administration of levothyroxine. During her treatment course, the patient experienced an adverse reaction to methimazole, complicating management by precluding the use of conventional treatment protocols for severe thyrotoxicosis. TPE was successfully used to stabilize the patient over the course of two plasma exchanges without the need for thyroidectomy or radio-iodine ablation of the thyroid post stabilization, and was able to be safely discharged home.