Plasma Exchange and Hemoperfusion in Iodine-Induced Thyrotoxicosis

Abstract

Iodine-induced thyrotoxicosis is a life-threatening disease. Plasma exchange and hemoperfusion are the available means of detoxication. Both methods were applied repeatedly to 4 patients with iodine-induced thyrotoxicosis, and the efficacy of these treatment methods was compared. Thyroxine plasma levels were decreased by 33%, while the calculated body stores were reduced by 18 % during plasma exchange. Hemoperfusion was less effective. With both methods, a rebound of plasma levels was seen. Improvement of the clinical condition was delayed for 1 week after discontinuation of treatment. One patient died, probably because detoxication was discontinued too soon after the thyroid hormone levels had normalized. Plasma exchange by using albumin (120 g/4,000ml = 30 g/l) as replacement fluid is superior to that by using fresh-frozen plasma (2,000 ml/4,000 ml), since less thyroxine is administered (19 vs. 160 nmol).

The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

“…The use of nonspecific sorbents such as charcoal or ion exchangers in direct contact with blood or plasma resulted in effective removal of toxic molecules, but was also complicated by bioincompatibility, which resulted in alarming drops in fibrinogen, and by activation of complements, which resulted in systemic inflammatory response (2–4). In addition, the direct contact between sorbents and plasma proteins has been shown to result in removal of hepatocyte growth factor (5) and a number of hormones such as growth hormone (3), triiodothyronine (T 3 ), tetraiodothyronine (T 4 ), (3,6–8), parathormone (9), testosterone, steroid hormones, and insulin (3,10,11).…”

Charcoal Hemoperfusion in the Treatment of Levothyroxine Intoxication

“…In the absence of specific treatments for iatrogenic thyrotoxicosis, extractive techniques such as peritoneal dialysis, plasmapheresis, and hemoperfusion through a resin bed or charcoal column have been used to remove excess circulating thyroid hormones (4,6,9,10).…”

“…It should be mentioned that the extraction process is not effective in situations characterized by ongoing production of thyroid hormones such as excessive iodine exposure (9). In these cases a rebound of serum T4 levels was observed after the extraction process was stopped.…”

Erkennung klinisch nicht vermuteter thyreoidaler Dysfunktion

“…Einerseits sind immer wieder klinisch nicht erkannte Fehlfunktionen der Schilddrüse aufgrund klinisch maskierter Symptomatik Ursache für Komplikationen, deren gravierendste Ausprägung die iatrogene Jod-induzierte Hyperthyreose ist. Selbst angesichts wirksamer Therapiemöglichkeiten durch hochdosierte Gabe von Thyreostatika, Plasmapherese und subtotale Thyreoidektomie bedeutet die -wenn auch seltenethyreotoxische Krise auch heute noch eine vitale Bedrohung (25). Andererseits ist eine ungezielte Diagnostik aus ökonomischen Gründen dann nicht zu rechtfertigen, wenn die Erkrankung in einer sehr niedrigen Häufigkeit angetroffen wird.…”