LAUSR

The utility of therapeutic plasma exchange (TPE) in acute thyrotoxicosis refractory to conventional therapy has been documented in case study literature. TPE has been shown to remove T3 and T4 bound to albumin, autoantibodies, catecholamines, and cytokines in patients with thyrotoxicosis. In clinical practice, TPE has been used as a treatment in refractory cases of acute thyrotoxicosis and as a bridge for those patients needing surgical treatment. At present, TPE is listed as an ASFA category III indication for thyrotoxicosis. We present a case of acute thyrotoxicosis and cardiogenic shock responsive to early TPE. A 27-year-old lady presented to our emergency department with dyspnea, nausea, and vomiting. She was found to be in atrial fibrillation with rapid ventricular response, hypotensive, and in acute respiratory distress requiring intubation. Her TSH was undetectable and her clinical condition rapidly declined. She developed acute cardiogenic shock (LVEF