Thyroid hormone extraction by plasma exchange: a study of extraction rate

Puy, Hervé; Lamoril, J.; Marcelli, J. M.; Lalau, J. D.; Debussche, Xavier; Quichaud, J; Desmet, G

doi:10.1016/0753-3322(92)90046-a

Cited by 8 publications

(11 citation statements)

References 5 publications

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“…The metabolically active part of the hormones is free, but over 99.5% of T4 (Thyroxine) and T3 (Triiodothyronine) are protein bound in the serum. TBG binds approximately 80% of circulating hormones; transthyretin and albumin are minor protein binders (49); albumin binds 10% of T4 and 20% of T3 (33). This technique decreases the effects of thyroid hormones by removing free thyroid hormones and, moreover, by replacing carrier proteins by unsaturated bound proteins of the replacement solution.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, Puy et al. report a total extraction of FT4 and FT3 from between 20 to 60% and between 20 to 40%, respectively, for TBG after three exchanges (33). Binimelis et al., in a small study on six patients, depict a disappearance rate of total thyroxine (TT4) that is 30‐fold greater with TPE than with standard medical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In our observations, thyroid hormone levels have a tendency to rise again in the next day after TPE. In some cases the FT3, FT4, and TSH do not decrease during the procedure and may even increase (30,33). This phenomenon is explained by a mobilization effect from the extravascular compartment and the establishment of a new equilibrium between free and intracellular rates (27).…”

Section: Discussionmentioning

confidence: 99%

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Role of Plasma Exchange in the Thyroid Storm

et al. 2011

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Abstract:Inadequately treated thyroid storm can lead to death. Therapeutic plasma exchange (TPE) is a suggested treatment when conventional treatments fail, but its indication is not well codified. We report our experience through three explicit cases. Three elderly patients were admitted to our hospital for cardiac or neurologic symptoms due to thyroid storm. After initiation of conventional therapy, TPE was performed with clinical and biological improvement. The speed of symptom resolution varies depending on the severity. This technique must be carried out by experienced medical staff as many complications can occur; nevertheless, in our patients with severe comorbidities, no complications occurred. The action of TPE mainly results from plasma removal of cytokines, putative antibodies, and thyroid hormones and their bound proteins. TPE has a transitory effect and thus should be associated with other thyroid blockers. When there are threatening symptoms, TPE should be done early, without waiting for the efficiency of conventional treatment, since it is the fastest method known for the improvement of the clinical condition. We also suggest starting TPE in case of neurologic symptoms because of very slow and incomplete regression. The Burch and Wartofsky score seems to be a helpful tool in establishing the diagnosis of thyroid storm and for deciding on when to initiate TPE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Role of Plasma Exchange in the Thyroid Storm

et al. 2011

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“…Studies have been conducted to determine the required duration of PEs to be fully effective in extracting thyroid hormones (21). During the clinical management of our patient, we did not evaluate the amount of thyroid hormone extracted during plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis

Jha

Waghdhare

Reddi

et al. 2012

Thyroid

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“…The number of cycles required for clinical and laboratory improvement has varied from single to multiple cycles of TPE. Puy et al report a case due to excess ingestion, treated over several TPE cycles.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange

Shah

Mbughuni

Burgstaler

et al. 2017

J of Clinical Apheresis

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Thyroid storm or severe thyrotoxicosis results from extreme thyroid hormone elevation. Therapy includes medical management to prevent hormone production, release, recycling, and peripheral conversion while stabilizing adrenergic tone. Thyroid dysfunction is the usual cause but it can be due to excessive thyroid hormone ingestion. Therapeutic plasma exchange (TPE) has been used to rapidly remove protein-bound thyroid hormone. American Society for Apheresis guidelines make a weak recommendation to perform TPE in selected patients in the treatment of thyrotoxicosis based on low quality evidence. We present a case of excessive thyroid replacement hormone ingestion treated by TPE. The patient presented with the clinical picture of thyroid storm, including cardiovascular compromise and massively elevated total and free T3 (525 ng/dL, nl 80-200 ng/dL and 28 pg/mL, nl 2.0-3.5 11 pg/mL), which failed medical therapy. A single, one plasma volume TPE was performed. Both total and free T3 demonstrated substantial declines immediately after TPE with the patient's mental status returning to near-normal. Thyroid hormone extraction efficiency and collection efficacy were calculated as 37.1% and 40.8%, respectively. Prior to discharge on day 6, the patient's compounding pharmacy indicated that a "bad batch" of bovine thyroid gland derived replacement hormone had been produced. TPE appears to be effective in removing protein bound thyroid hormone in extreme iatrogenic thyrotoxicosis.

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Thyroid hormone extraction by plasma exchange: a study of extraction rate

Cited by 8 publications

References 5 publications

Role of Plasma Exchange in the Thyroid Storm

Role of Plasma Exchange in the Thyroid Storm

Thyroid Storm Due to Inappropriate Administration of a Compounded Thyroid Hormone Preparation Successfully Treated with Plasmapheresis

Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange

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