Therapeutic plasma exchange with albumin as a valuable method of preparing thyrotoxic patients for a life‐saving thyroidectomy

Tańska, Kamila; Leszczyńska, Dorota; Glinicki, Piotr; Kapuścińska, Renata; Szczepkowski, Marek; Dedecjus, Marek; Stachlewska-Nasfeter, Elżbieta; Brym, Izabela; Żelek, Tomasz; Daniewska, Dorota; Gietka-Czernel, Małgorzata

doi:10.1002/jca.21866

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Despite the risk of thyroid storm, surgery appears to be a reasonably safe option in comparison to no treatment or to a continuation of failing medical treatment [12]. Therapeutic plasma exchange may be also of benefit prior to a thyroidectomy [13], though failures of this approach were also described [14]. As the risk of thyroid storm remains real, in our opinion, all measures should be applied to obtain the best possible FT3 concentrations prior to surgery, particularly in the setting of a high FT4, which remains as a sort of reservoir of thyroid hormones.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

Lewandowski,

Kawalec,

Kusiński

et al. 2024

JCM

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Background: Amiodarone-induced thyrotoxicosis (AIT) may pose treatment challenges. We present a series of patients in which we achieved the normalisation of free T3 (FT3) using intravenous methylprednisolone (ivMP) in AIT refractory to thiamazole and oral prednisone. Namely, in three males (aged 56, 50 and 64, all with a history of AF and/or a low ejection fraction), an addition of ivMP resulted in the normalisation of FT3, which allowed successful thyroidectomy. In another case of a 65-year-old man, we initially succeeded in the normalisation of FT3 using ivMP from FT4 > 7.77 ng/dL (0.93–1.7) to 2.41 ng/dL and in that of FT3 from 14.95 pg/mL (2–4.4) to 2.05 pg/mL), but four weeks after stopping ivMP, despite the continuation of thiamazole and prednisone, there was rebound thyrotoxicosis: FT4 > 7.77 ng/dL and FT3—5.46 pg/mL. Intravenous MP was restated leading to a decline in FT4 to 2.51 ng/dL and in FT3 to 1.92 pg/mL, thus allowing a successful thyroidectomy. Finally, in a 78-year-old man with AF, goitre, and AIT resistant to thiamazole, prednisone and lithium carbonate, we obtained a reduction in FT4 to 1.51 ng/dL and in FT3 to 3.17 pg/mL after seven pulses of ivMP. Oral prednisone was gradually reduced and successfully stopped about six months later. He remained on low-dose thiamazole (5 mg od). Conclusions: Pulse ivMP in addition to oral steroids may be a useful adjunct therapy either for the preparation of a thyroidectomy or as a treatment modality in drug-resistant AIT. Though a total cure is possible, there is a danger of a rebound worsening of thyrotoxicosis after premature discontinuation of ivMP.

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Section: Discussionmentioning

confidence: 99%

The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

Lewandowski,

Kawalec,

Kusiński

et al. 2024

JCM

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“…2 In patients with severe hyperthyroidism, in cases of thyroid storm and in cases where ATD cannot be used due to side effects or ineffectiveness, plasmapheresis therapy can be used to provide euthyroidism before permanent treatment. [3][4][5][6][7][8] Therapeutic plasma exchange (TPE) is the process of replacing patient plasma with albumin or fresh frozen plasma (FFP). During this treatment, thyroid hormones, high molecular weight substances, autoantibodies, immune complexes, cytokines, catecholamines and thyroid-binding globulins are also cleared from the patient's blood.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients

SARIDAŞ

TURNA

Aydemir

et al. 2022

Turkish Journal of Internal Medicine

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Background Therapeutic plasma exchange (TPE) is a treatment method that can be used to provide euthyroidism before permanent treatment in patients with severe thyrotoxicosis, in cases of thyroid storm and in cases where antithyroid drug (ATD) cannot be used due to side effects or ineffectiveness. This study presented our results and experience on TPE in thyrotoxic patients. Material and MethodsThe data of 10 patients who underwent plasmapheresis for thyrotoxicosis in Bursa Uludag University Faculty of Medicine Endocrinology Clinic were retrospectively analyzed and compared with the literature. Results Ten patients, 6 female and 4 male, were included. The cause of hyperthyroidism was Graves' disease in 8 patients and toxic multinodular goiter (TMNG) in 2 patients. It was observed that the reason for applying plasmapheresis in the patients was primarily due to toxic hepatitis. The mean number of plasmapheresis required to maintain euthyroidism was 4 (1-8). While no difference was found between the thyroid-stimulating hormone (TSH) results before and after TPE, free T4 (fT4) and free T3 (fT3) values were statistically significantly lower after TPE. It was observed that the leukocytes were considerably higher after TPE and the sodium and calcium values were markedly lower after TPE in the patients. After TPE, 7 patients underwent total thyroidectomy, 1 patient received radioactive iodine (RAI) treatment, and 2 were discharged with ATD treatment. Conclusions TPE is an effective and safe treatment option that can be applied in cases where it is necessary to provide rapid euthyroidism before permanent treatments or non-thyroid surgical procedures or to treat life-threatening thyrotoxicosis. It requires experience in application and follow-up and provides rapid euthyroidism when performed in experienced centres.

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“…Plasmapheresis/therapeutic plasma exchange (TPE) was first reported in 1970 to treat three patients with thyroid storm 2 . Since then, it has been reported as a treatment option for patients with thyrotoxicosis and thyroid storm, 3,4 inadequate response to medical treatment, 5 contraindications to therapy or severe side effects, 6‐8 preparing patients for life‐saving thyroidectomy 9,10 or other urgent surgeries 11 . The rationale for plasma exchange in severe thyrotoxicosis is to remove not only thyroid hormones and their binding proteins from the circulating pool but also reducing plasma levels of other substances associated with the clinical syndrome, such as cytokines, antibodies, and catecholamines, while providing new binding sites for newly formed thyroid hormones in those with hyperthyroidism or reducing the levels of drugs such as amiodarone 12 …”

Section: Introductionmentioning

confidence: 99%

Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study

Builes

Rodriguez-Arrieta

Román-Gonzaléz

et al. 2021

J of Clinical Apheresis

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Background and aims Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired. Methods We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment. Results Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta‐blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients. Conclusions Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non‐thyroid surgery. It is limited by its cost and the need for highly specialized resources.

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Therapeutic plasma exchange with albumin as a valuable method of preparing thyrotoxic patients for a life‐saving thyroidectomy

Cited by 8 publications

References 10 publications

The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients

Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study

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