Q: What is the life saving measure in thyroid storm when all conventional treatments fail?

Answer: Plasmapheresis

Plasmapheresis causes removal of cytokines, putative antibodies, and thyroid hormones and their bound proteins. Few pearls to remember

• Though plasmapheresis is the fastest method for the improvement of the thyroid storm, it has a transitory effect and thus should be associated with other thyroid blockers.
• In anticipated life threatening situation, plasmapheresis should be done early without waiting for the efficiency of conventional treatment.
• In cases involving neurologic symptoms, plasmapheresis should be high on list for treatment.

Petry J, Van Schil PE, Abrams P, Jorens PG. Plasmapheresis as effective treatment for thyrotoxic storm after sleeve pneumonectomy. Ann Thorac Surg. May 2004;77(5):1839-41.