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All Journal Ina Kidney The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Wardoyo, Elizabeth Yasmine
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Successful Management of Thyroid Storm with Continuous Renal Replacement Therapy without Plasma Exchange Mulyadi, Calvin Kurnia; Wardoyo, Elizabeth Yasmine; Sari, Anggraini Permata; Yohanes, Aryan; Sarwono, Johanes; Allisha, Fidkya; Epriliawati, Marina; Mokoagow, Muhammad Ikhsan
Indonesian Journal of Kidney and Hypertension Vol 2 No 2 (2025): Volume 2 No. 2, August 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i2.195

Abstract

Background: Thyroid storm is a life-threatening endocrine emergency that needs urgent management. Conventional therapies, however, may not always yield satisfactory outcome. Hereby, we report a case of refractory thyroid storm with hemodynamic and cardiac instability that showed significant improvement following continuous renal replacement therapy (CRRT) instead of therapeutic apheresis. Case Illustration: A 46-year-old woman presented to the emergency department with severe thyrotoxicosis and pneumonia. On arrival, she was alert and hemodynamically stable. Physical examination revealed rapid irregular heart rate, fever, exophthalmos, diffuse goitre, and bilateral pulmonary rales. Laboratory findings indicated primary thyrotoxicosis, remarkable leukocytosis, and high procalcitonin that was consistent with sepsis. The Burch-Wartofsky score was 65, indicating thyroid storm. Clinical deterioration including loss of consciousness occurred on the next few days with electrocardiography changing into unstable supraventricular tachycardia despite optimal medical treatment administered to manage thyrotoxicosis and infection. Due to a suboptimal response, continuous veno-venous hemofiltration (CVVH) was initiated for 33 hours. This resulted in marked clinical improvement, including a reduction in free thyroxine (fT4), hemodynamic stabilization and recovery of consciousness. Discussion: While therapeutic plasma exchange (TPE) is the recommended adjunctive therapy for refractory thyroid storm according to the ASFA 2016 guidelines, it is often unavailable in many centers, particularly in low-resource settings. CRRT may serve as an alternative, offering hemodynamic stabilization through mechanisms not yet fully understood. Conclusion: CRRT may be considered a safe and effective alternative treatment for thyroid storm in patients who are refractory to standard medical therapy and particularly for those presenting with hemodynamic instability.
Clinical, Laboratory, and Perioperative Management Characteristics in Liver Resection Cases in Fatmawati General Hospital Darnindro, Nikko; Marsigit, Jessica; Nugroho, Adianto; Sari, Anggraini Permata; Taufik, M Azhari; Adrisyel, Dieby; wardoyo, Elizabeth Yasmine; Ratnaningrum, Apriliana; Darmawan, Danny
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 3 (2022): VOLUME 23, NUMBER 3, December 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2332022209-215

Abstract

Background: Liver resection has been associated with high morbidity and mortality. Improvements in surgical, anesthetic techniques, and multidisciplinary collaborations, can reduce post-surgery complications and mortality. This study aims to provide an overview of the perioperative conditions and the treatments after liver resection.Method: A retrospective study of liver resection surgery between 2019-2020 at Fatmawati Hospital.Results: Of the 11 patients, mean age was 49.7 years, with 63.6% being female and mean BMI was 22 kg/m2, hypertension and diabetes mellitus were found in 18.2% and 18.2% of patients respectively. HBsAg reactive was detected in 36.3%. Based on pathology, HCC was found in 54.5%, while 18.2% were metastatic adenocarcinoma. Postoperative hyperglycemia was observed in 90.9%. Increase in AST and ALT 3 upper limit normal were found in 90% and 72.7% of patients. Mean AST and ALT were 408.3 U/L and 246.18 U/L. Mean urine production at 8-, 16-, 24-, and 48-hours post-operative were 757, 1624, 1880 and 1930 cc. Urine production ≤ 500 cc in the first 8 hours was detected in 44.4% of patients, and elevated creatinine levels 50% post-operative occurred at 11.1%, 22.2%, 22.2% at 16, 24, and 48 hours post-op. Renal support therapy was given to 5 of the 11 patients. D-Dimer levels were increased in all patients.Conclusion: Adequate fluid monitoring and metabolic disorders control such as glucose levels, acute kidney injury, coagulation disorders, and bleeding are important things that need to be considered in the perioperative management of liver resection.
Co-Authors Adianto Nugroho Adrisyel, Dieby Allisha, Fidkya Darmawan, Danny Epriliawati, Marina Marsigit, Jessica Mokoagow, Muhammad Ikhsan Mulyadi, Calvin Kurnia Nikko Darnindro Ratnaningrum, Apriliana Sari, Anggraini Permata Sarwono, Johanes Taufik, M Azhari Yohanes, Aryan