The role of therapeutic plasmapheresis in patients with hyperthyroidism

Baser, Ozden Ozdemir; Çetin, Zeynep; Çatak, Merve; Köseoğlu, Derya; Berker, Dilek

doi:10.1016/j.transci.2020.102744

Cited by 13 publications

(6 citation statements)

References 21 publications

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“…As reported previously in several case series, hyperthyroidism, especially Graves' disease, is the most common underlying thyroid condition, and most of the patients undergoing TPE are women 16,17 . Graves' disease is the most common form of hyperthyroidism, and women are the most frequently affected by it.…”

Section: Discussionmentioning

confidence: 59%

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

Builes

Rodriguez-Arrieta

Román-Gonzaléz

et al. 2021

J of Clinical Apheresis

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Background and aims Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired. Methods We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment. Results Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta‐blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients. Conclusions Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non‐thyroid surgery. It is limited by its cost and the need for highly specialized resources.

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Section: Discussionmentioning

confidence: 59%

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

Builes

Rodriguez-Arrieta

Román-Gonzaléz

et al. 2021

J of Clinical Apheresis

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“…A previous study demonstrated that an ALSS improved the safety of 131 I treatment for patients with GD and LD ( 19 ). After the use of the ALSS, the decreases in the mean free triiodothyronine (FT3) and free thyroxine (FT4) levels were 57% and 73% ( 20 ), respectively. However, another study showed no significant decreases in the FT3 and FT4 levels ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Rao

Wang²,

Ren³

et al. 2022

Front. Endocrinol.

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ObjectiveTreatment decision-making in Graves’ disease (GD) with severe liver dysfunction (LD) is a clinical challenge. This research was carried out to evaluate the effect of radioiodine (131I) with or without an artificial liver support system (ALSS) in GD patients with severe LD.MethodsIn total, 45 patients diagnosed with GD and severe LD were enrolled and allocated to two groups: patients treated with 131I alone (n=30) (Group A)and patients by a combination of 131I and ALSS (n=15)(Group B). Liver function, thyroid hormone concentrations, therapeutic efficacy, and the cost of treatment were compared between the two groups.ResultsThyroid hormone concentrations were lower 2 weeks after 131I treatment, but no deterioration in liver function was identified. There was no statistically significant difference in the treatment efficacy between the two groups. The hospital stay, total cost, and daily cost were lower in patients treated with 131I alone than in those treated with 131I and an ALSS (p<0.05).ConclusionThe key point of treating GD patients with severe LD is to control the GD.131I is recommended as an effective and safe and should be applied as soon as possible once the diagnosis is clarified; however, when used in combination with an ALSS, there was no substantial improvement in therapeutic efficacy.

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“…24 TPE treatment has been described in 91 non-pregnant individuals with GD. [25][26][27][28][29][30] Use of TPE for hyperthyroidism in pregnant women [31][32][33] or during molar pregnancies [34][35][36] has only been rarely reported. No controlled trial has been performed.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic plasma exchange for Graves’ disease in pregnancy

et al. 2021

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Graves’ disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves’ disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.

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The role of therapeutic plasmapheresis in patients with hyperthyroidism

Cited by 13 publications

References 21 publications

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

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

Effect of 131I with and without artificial liver support system in patients with Graves’ disease and severe liver dysfunction: A retrospective study

Therapeutic plasma exchange for Graves’ disease in pregnancy

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