<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022016000100041</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Plasma separación en el manejo de la tormenta tiroidea: reporte de un caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Plasma separation in the management of the thyroid storm: report of a case]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bolaños-Rodríguez]]></surname>
<given-names><![CDATA[Hernán]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alvarado-Vega]]></surname>
<given-names><![CDATA[Ademir]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Salas-Segura]]></surname>
<given-names><![CDATA[Donato]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Servicio de Endocrinología Servicio de Endocrinología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,aff2  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital &#8220;Dr. Rafael Angel Calderón Guardia&#8221; Medicina crítica y terapia intensiva unidad de cuidado intensivo ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<volume>58</volume>
<numero>1</numero>
<fpage>41</fpage>
<lpage>43</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022016000100041&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022016000100041&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022016000100041&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Considerada como la forma de presentación más severa del hipertiroidismo, la tormenta tiroidea es una condición clínica en la cual el estado severo de tirotoxicosis puede tener repercusiones hemodinámicas importantes que pueden poner en peligro la vida de los pacientes. Se reporta un caso clínico de un paciente masculino de 41 años conocido portador de enfermedad de Graves con tratamiento irregular el cual ingresa al servicio de emergencias con un cuadro de dolor torácico atípico, evidenciándose una arritmia cardiaca por fibrilación atrial y al examen físico con exoftalmos bilateral, franca atrofia muscular y presencia de bocio grado II. El cuadro clínico evoluciona de forma tórpida a una insuficiencia cardiaca congestiva y posteriormente a uso de vasopresores e intubación endotraqueal. Dada la necesidad de disminuir rápidamente la fracción libre de la hormona tiroidea, asociando mediacamentos antitiroideos se decide iniciar terapia con plasmaseparación.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Considered as the most severe form of hyperthyroidism, thyroid storm is a clinical condition in which the severe state of thyrotoxicosis can lead to important hemodynamic repercussions that can be life threatening. We report a case of a 41-year-old male patient known to have Graves Disease with an irregular medical control that presents to the emergency department complaining of atypical chest pain, associating the presence of cardiac arrhythmia due to atrial fibrillation, with evident bilateral exophthalmos, severe muscular atrophy and a grade II goiter. His condition worsens to a severe heart failure and afterwards to use of vasopressors and endotracheal intubation. Given the need to reduce rapidly the free fraction of the thyroid hormones, in association with antithyroid medications, the decision was to start therapy with plasma separation.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Tormenta tiroidea]]></kwd>
<kwd lng="es"><![CDATA[eliminación de componentes sanguíneos]]></kwd>
<kwd lng="es"><![CDATA[tirotoxicosis]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad de Graves.]]></kwd>
<kwd lng="en"><![CDATA[Thyroid storm]]></kwd>
<kwd lng="en"><![CDATA[blood component removal]]></kwd>
<kwd lng="en"><![CDATA[thyrotoxicosis]]></kwd>
<kwd lng="en"><![CDATA[Graves disease.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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