Extracorporeal membrane oxygenation support and total thyroidectomy in patients with refractory thyroid storm: case series and literature review

Abstract

Thyroid storm (TS) is a rare but life-threatening complication of hyperthyroidism in which multiorgan failure (MOF) is the most common cause of death. Early diagnosis and treatment of TS are challenging. We presented two cases with refractory TS complicated with arrhythmia, cardiac arrest, cardiogenic shock and MOF and were not responding to medical treatment, therapeutic plasma exchange or continuous renal replacement therapy. The combination of extracorporeal membrane oxygenation (ECMO) and early thyroidectomy was the mainstay treatment that was performed with no complications. MOF was resolved and patients were doing well in the outpatient clinic follow-up. Precautions concerning the beta blockers and anti-thyroid medications use in TS, especially in the acute setting, should be considered. Upon its availability, the use of ECMO and early thyroidectomy is efficient. This is most applicable in patients not responding to medical treatment or patients who develop complications related to the TS and its medical treatment.