Preoperative therapeutic plasma exchange in patients with thyrotoxicosis

Abstract

The purpose of this report was to determine the effectiveness of therapeutic plasma exchange (TPE) in preoperative preparation of patients with thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with thyrotoxicosis and those who prepared surgery with plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during antithyroid drug treatment. The indications for plasmapheresis in all patients with severe thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to antithyroid drugs (three patients), iodine-induced thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operation (one patient). After TPE, we observed a marked decrease in free thyroxin (FT3) and free triiodothyronin (FT4) levels; however, the decline in the biochemical values were not statically significant (P > 0.62, P > 0.15). Although both FT3 and FT4 levels remained above the normal limits in two of 11 patients, the signs and symptoms of thyrotoxicosis improved in all patients and no thyroid storm observed during the perioperative period. TPE can be considered a safe and effective alternative to prepare patients with thyrotoxicosis for surgery when drug treatment fails or is contraindicated and when emergency surgery is required.

Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

“…If no change is noted in the measurement of FT4 and FT3 at the sixth hour post therapy, there is no justification for an additional TPE session. It should be noted, however, that any reductions in FT4 and FT3 could have a minimum, according to the reductions previously reported, ranging from 8.3-64.9% for FT4 and from 22.2-88-9% for FT3 [22]. Nevertheless, make a decision based for any change of FT4, FT3 and anti thyroid (RTSH) antibodies has a poor level of evidence.…”

“…While this is effective in the short-term, its effect is transient and so TPE cannot be used as definitive therapy. In an emergency or in the absence of response to other treatments, it is necessary, therefore, to resort to consolidation therapies such as thyroidectomy [3,22,23]. The therapy goal is not only to achieve a reduction in biochemical markers, however, but also to reduce the incidence of clinical outcomes such as thyroid storm and associated mortality.…”

Thyrotoxicosis Associated with Cholestatic Jaundice Treated with Therapeutic Plasma Exchange–Case Report

“…They observed a marked decrease in free thyroxin (FT4) and free triiodothyronin (FT3) levels in the preoperative period, enabling patients to undergo surgery more safely [17].…”

What should an orthopaedic surgeon do to not encounter thyroid storm?

“…Bu girişimlerle tiroit fırtınası kontrol altına alınamazsa son çare olarak hormonların dolaşımdan hızla uzaklaştırılması amacıyla plazmaferez düşünülebilir (11,18) (Tablo 3).…”

“…Bunların dışında, kas protein yıkımına neden olan travmalar veya kosta kırıkları-na yol açan göğüs kafesi travması, pürülan artrit gibi enfektif olgularda, kalça osteokondromatozisinde, artroskopik sinovektomi gibi çeşitli ortopedik cerrahi operasyonlar esnasında veya sonrasında tiroit fırtına-sı gözlemlenebilmektedir (7)(8)(9)(10)(11)(12)(13)(14) .…”