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      Switching Therapy from Intravenous Landiolol to Transdermal Bisoprolol in a Patient with Thyroid Storm Complicated by Decompensated Heart Failure and Gastrointestinal Dysfunction

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          Abstract

          Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.

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          Most cited references20

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          Life-threatening thyrotoxicosis. Thyroid storm.

          Although important strides in recognition and therapy have significantly reduced the mortality in this disorder from the nearly 100% fatality rate noted by Lahey, survival is by no means guaranteed. More recent series have yielded fatality rates between 20% and 50%. Although some authors have attributed this improvement, in part, to a relaxation of the diagnostic criteria for thyroid storm, it more likely represents improvements in early recognition and the beneficial effects of the serial addition of antithyroid, corticosteroid, and antiadrenergic therapies to the treatment of this disorder. Thyroid storm is a dreaded, fortunately rare complication of a very common disorder. Most cases of thyroid storm occur following a precipitating event or intercurrent illness. Effective management is predicated on a prompt recognition of impending thyroid storm which is, in turn, dependent on a thorough knowledge of both the typical and atypical presentations of this disorder. An unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.
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            Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013).

            (2014)
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              Thyroid Storm: An Updated Review

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                Author and article information

                Journal
                Intern Med
                Intern. Med
                Internal Medicine
                The Japanese Society of Internal Medicine
                0918-2918
                1349-7235
                6 September 2017
                1 October 2017
                : 56
                : 19
                : 2603-2609
                Affiliations
                [1 ]Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
                [2 ]Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Japan
                [3 ]Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
                [4 ]Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan
                Author notes

                Correspondence to Dr. Shigeo Godo, s-godo@ 123456cardio.med.tohoku.ac.jp

                Article
                10.2169/internalmedicine.8846-17
                5658526
                28883252
                82830716-53c3-4de5-9018-dddc44aa704e
                Copyright © 2017 by The Japanese Society of Internal Medicine

                The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 January 2017
                : 20 February 2017
                Categories
                Case Report

                acute heart failure,atrial fibrillation,bisoprolol transdermal patch,critical care,landiolol,thyroid storm

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