Role of plasma exchange in autoimmune hyperthyroidism complicated by severe tiamazol-induced cholestatic jaundice

Miljić, Dragana; Stojanović, Marko; Jesic, Rada; Bogadnović, G.; Popović, Vladimir

doi:10.1016/j.transci.2013.05.007

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Unfortunately, information regarding the evolution of antibody levels before and after TPE was not available. A decrease in TSH receptor antibodies after 4 TPEs has been described in a case report of GD with an ATD contraindication [14], but information is lacking in other published cohort studies [7, 11, 12, 15].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange in Refractory Hyperthyroidism

Saie¹,

Ghander²,

Saheb³

et al. 2020

Eur Thyroid J

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Introduction: Hyperthyroid patients who are unresponsive to medical treatment remain a challenging clinical problem. Objective: The goal of our study was to evaluate the use of therapeutic plasma exchange (TPE) in hyperthyroid patients and their outcome after TPE. Method: We retrospectively reviewed 22 patients who underwent TPE for refractory thyrotoxicosis in our institution: 13 with Graves’ disease, 7 with amiodarone-induced thyrotoxicosis (AIT), 1 with toxic goiter, and 1 pregnant patient with familial nonautoimmune thyrotoxicosis. Results: Before TPE, all patients had severe hyperthyroidism, and antithyroid drugs were either contraindicated or not sufficiently effective to restore euthyroidism promptly. After all the TPEs, free T₄ (fT4) decreased significantly by 48% (p = 0.001) and fT3 by 52% (p = 0.0001). The median number of TPE sessions per patient was 4 (range: 1–10). There were no complications during the 91 TPE sessions. Total thyroidectomy with no severe side effects was performed on 16/22 patients and 1 other patient was treated with radioactive iodine. One patient died from severe thyrotoxicosis during medical care. The remaining 4 patients were followed up without any radical treatment. For all 7 patients with AIT, iterative TPE led to a significant clinical improvement, and amiodarone was continued for 1 patient. Available treatments were continued between TPE sessions (cholestyramine for 13 patients [60%] and glucocorticoids for 16 patients [73%]). Conclusion: TPE allowed a safe decrease of 50% in thyroid hormone levels, and it should be considered for refractory hyperthyroid patients when medical treatments are contraindicated or have failed to restore euthyroidism, irrespective of the etiology of the thyrotoxicosis.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange in Refractory Hyperthyroidism

Saie¹,

Ghander²,

Saheb³

et al. 2020

Eur Thyroid J

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“…Two to five courses of TPE were administered in patients with GD or toxic nodular goiter where thyroidal hyperfunction was not controlled by antithyroid drugs. In some instances, TPE was employed when antithyroid drugs were contraindicated, due to such adverse effects as agranulocytosis or hepatotoxicity ( 5 9 10 11 ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis

Min

Phung

et al. 2015

J Korean Med Sci

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Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.Graphical Abstract

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“…Patients who experience side effects of ATDs, namely agranulocytosis and hepatotoxicity, require an alternate treatment modality (1). In those with severe thyrotoxicosis and impending storm requiring hospitalization, therapeutic plasma exchange (TPE) has been used to acutely manage thyrotoxicosis and thyroid storm as a bridge to thyroidectomy; however, the role of TPE in routine management has not been adequately established (category III) by the American Society of Apheresis (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Plasma Exchange as a Bridge to Total Thyroidectomy in Patients with Severe Thyrotoxicosis

Tieken

Paramasivan

Goldner

et al. 2020

AACE Clinical Case Reports

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Objective: Graves disease is the most common cause of thyrotoxicosis. Medical management is the first-line treatment but may be contraindicated or ineffective. In patients with severe, refractory thyrotoxicosis therapeutic plasma exchange (TPE) may be indicated as a bridge to thyroidectomy. Methods: We present 3 cases of thyrotoxicosis refractory to medical management that were successfully treated with TPE and subsequent total thyroidectomy, and provide an analysis of the response to therapy via a change in free thyroxine (fT4) levels throughout their treatment course. Results: The average change in fT4 per liter of fluid exchanged was 0.37 ng/dL (SD = 0.08) and the average percentage change of fT4 after each treatment was 20.7% (SD = 8.28). The mean decrease in fT4 after 4 TPE treatments was 57.4%. All patients successfully underwent total thyroidectomy without complication and were discharged from the hospital. Conclusion: TPE should be considered for thyrotoxic patients with severe hyperthyroidism or thyroid storm refractory to medical management or contraindications to antithyroid drugs who need a bridge to total thyroidectomy. In these cases, TPE was a safe and effective treatment that enabled definitive management with thyroidectomy and may be considered in other patients with severe refractory hyperthyroidism or thyrotoxicosis.

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Role of plasma exchange in autoimmune hyperthyroidism complicated by severe tiamazol-induced cholestatic jaundice

Cited by 10 publications

References 8 publications

Therapeutic Plasma Exchange in Refractory Hyperthyroidism

Therapeutic Plasma Exchange in Refractory Hyperthyroidism

Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis

Therapeutic Plasma Exchange as a Bridge to Total Thyroidectomy in Patients with Severe Thyrotoxicosis

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