血漿交換と血液濾過透析の併用療法が奏功した肝機能障害を伴った甲状腺クリーゼの1例(アフェレシスと希少疾患)

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We report a 28-year-old female patient in whom thyroid storm associated with liver dysfunction was dramatically improved by plasmapheresis. The patient suffered from thyroid gland enlargement, weight loss, and palpitations for 2 years, but had never visited a hospital Unfortunately with the onset of urinary tract infection, she had thyroid storm and liver dysfunction. As there was no remarkable improvement with conventional therapy, hemodiafiltration (HDF) and plasma exchange (PE) was carried out using fresh frozen plasma. Serum thyroid hormone concentrations were decreased after combination therapy. Consequently, her critical condition improved quickly. The half-life of thyroid hormones is so long that quick improvement is not always achieved even by sufficient doses of antithyroid drugs. Thyroid hormone in the removal of PE was considered to be useful in the treatment Moreover HDF could be preventing the side effects of PE such as alkalosis by citric acid and electrolyte disturbances. Therefore, the combination therapy of HDF and PE may have been effective in relieving the life-threatening state in our patient with thyroid storm complicated by liver dysfunction.
2011-05-31