Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Abstract

Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.

Preoperative therapeutic plasma exchange in patients with thyrotoxicosis

“…However, in patients with iatrogenic thyrotoxicosis or for whom antithyroid drugs are contraindicated or who are resistant to antithyroid drugs, further therapies are needed to restore euthyroid hormone status. The reported cases suggested that therapeutic plasma exchange (TPE) has been used as an additional treatment or preparation for surgery [5][6][7].…”

A Unique Presentation Of Thyroid Storm And Myopericarditis In A Young Muscular Man

“…Other treatment options include plasmapheresis and therapeutic plasma exchange, which can quickly reduce the levels of thyroid hormone within several hours (9). This can be considered in cases of exogenous thyroid hormone ingestion, when euthyroidism needs to be restored very quickly, or when the patient has contraindications to all other therapeutic options (10,11). Another choice is oral cholestyramine resin, which binds to T4 and T3, preventing enterohepatic recirculation, leading to excretion (9).…”

Anaesthetic Management In A Heart Transplantation Patient With Amiodarone Associated Thyrotoxicosis

“…Öz-bey ve ark. (11) dört Graves hastasında plazmaferezin serum T3 konsantrasyonunu % 40-78, FT4 düzeyini ise % 69 oranında azalttığını ve tiroidektomiye yakın sonuçlar elde ettiklerini bildirmişlerdir. Güvenç ve ark.…”