Rescue therapies in Thyroid storm

Q: All of the following has been used or suggested to have beneficial effects in the management of Thyroid storm except?

A) Plasmapheresis 
B) Lithium 
C) Cholestyramine 
D) Glucocorticoids 
E) Aspirin


Answer: E

The objective of the above question is to highlight the possible role of plasmapheresis and lithium in the management of thyroid storm as adjuvant use of steroid and cholestyramine are relatively known in this disease.

Also, it is universally known to stay away from aspirin in thyroid storm as it releases thyroxine from protein binding sites.

Plasmapheresis is particularly useful if a thyroid storm is caused by a drug overdose but it can be attempted as a last-ditch therapy. Plasmapheresis is suggested in thyroid storm as theoretically can remove cytokines, antibodies, and thyroid hormones from plasma. 1

Lithium can acutely block the release of thyroid hormone, and this side effect of lithium can be utilized in a thyroid storm. 2

#endocrine



References:

1. Muller C, Perrin P, Faller B, et al. Role of plasma exchange in the thyroid storm. Ther Apher Dial 2011; 15:522.

2. Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010;1(3):139-45.