Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients


Mercan Sarıdaş F., Zor T., Aydemir E., Ateş C., Hocaoğlu E., Cander S., ...More

TURKISH JOURNAL OF INTERNAL MEDICINE, vol.4, pp.93-99, 2022 (Peer-Reviewed Journal)

Abstract

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 Methods: The 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.