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

Builes, Carlos; Rodriguez-Arrieta, Luis A; Román-Gonzaléz, Alejandro; Prieto-Saldarriaga, Carolina; Álvarez-Payares, José C; Builes-Barrera, Carlos Alfonso; Arango-Toro, Clara María

doi:10.1002/jca.21927

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…In addition to lowering serum T 3 levels, patients should be treated in the intensive care unit and any precipitating illness should be addressed . Plasmapheresis to lower circulating T 3 levels may be considered in refractory cases …”

Section: Methodsmentioning

confidence: 99%

Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Section: Methodsmentioning

confidence: 99%

Hyperthyroidism

Lee,

Pearce

2023

JAMA

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“…In severe cases in which conventional therapy is not effective or contraindicated, or clearance of hormone is necessary for survival, plasmapheresis can be used to achieve clinical stability [ 2 ]. Plasmapheresis is effective in removing pathologic substances from the plasma in numerous previously reported hematologic, neurologic, and renal disorders [ 3 ]. Its role is less established in thyroid storm due to the availability of medical therapy for treatment and the rarity of the condition [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Use of Plasmapheresis in a Severe Case of Amiodarone-Induced Thyrotoxicosis

Moazezi,

Koh

2023

JCEM Case Reports

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Amiodarone-induced thyrotoxicosis (AIT) can be difficult to treat since amiodarone's long half-life leads to a persistent effect on thyroid function. We present a case of a 74-year-old male with severe AIT who presented with altered mentation and ultimately required intubation and intensive care for management of thyroid storm. Standard medical therapy for treatment of thyroid storm was initiated immediately, but the patient remained unresponsive with worsening biochemical parameters with increasing total T3 levels and sustained elevated levels of free T4 after 5 days of medical management. Due to the lack of a clinical and biochemical response to conventional medical therapy, the patient was started on plasmapheresis and underwent a total of 7 cycles of plasmapheresis over a period of 10 days. He significantly improved with plasmapheresis and was successfully bridged to a total thyroidectomy, which was completed without complications.

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“…y a veces se aprecia una discordancia entre la mejoría clínica y la bioquímica (descenso moderado de los niveles hormonales con importante mejoría sintomática). Sin embargo, existe poca experiencia publicada, limitándose la mayoría a series de casos (4) .…”

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