Title:Management of Cardiogenic Shock due to Thyrotoxicosis: A Systematic Literature Review
VOLUME: 16 ISSUE: 4
Author(s):Milad Modarresi, Ahmed Amro*, Mohammad Amro, Amal Sobeih, Uzo Okoro, Kanaan Mansoor, Carlos Rueda, Rawan Elhamdani, Nesreen BenHamed, Timothy Kocher and Mehiar Elhamdani
Affiliation:Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, School of Medicine. Misr University of Science and Technology, Cairo, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, School of Medicine, AL-Najah University, Nablus, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755, Department of Cardiology/Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV-25755
Keywords:Thyrotoxicosis, cardiogenic shock, shock, thyroid storm, ECMO, impella, therapeutic plasma exchange.
Abstract:Background: A grave complication of thyrotoxicosis, or thyroid storm, is the development
of heart failure and cardiomyopathy. Recognizing this condition is imperative in preventing
further left ventricular dysfunction and cardiogenic shock. This manuscript aims to review the literature
on cardiogenic shock associated with thyrotoxicosis and present management recommendations
on this rare condition.
Methods: A literature search was performed in December of 2018, using the PubMed medical
search engine. A systematic search was carried out using the keywords Thyroid Storm AND Cardiogenic
Shock and Thyrotoxicosis AND Shock.
Management: Decrease of thyroid hormone levels using therapeutic plasma exchange LV Unloading
and ventilation by Impella and Extracorporeal Mechanical Ventilation (ECMO).
Conclusion: Patients presenting with thyroid storm-induced shock may not be suitable candidates
for traditional management with β -adrenergic blockers (β-blockers). The use of β-blockers could
exasperate their condition. Through extensive literature review on this rare condition, the most effective
management was found to be therapeutic plasma exchange in order to decrease thyroid
hormone levels, which have direct toxic effect on the heart. Furthermore, the use of ECMO and
Impella is advised to reduce pressure on the heart and ensure the patient’s organs are well oxygenated
and perfused while the left ventricle is recovering.
