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

Tieken, Kelsey R.; Paramasivan, Ameena Madan; Goldner, Whitney; Yuil‐Valdes, Ana; Fingeret, Abbey L.

doi:10.4158/accr-2019-0132

Cited by 9 publications

(4 citation statements)

References 19 publications

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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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Section: Discussionmentioning

confidence: 99%

Therapeutic plasma exchange for Graves’ disease in pregnancy

et al. 2021

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“…Other alternatives have been proposed in such cases, such as cholestyramine and plasma exchange for the rapid development of euthyroidism before surgery [6] [12] [13]. Furthermore, a herbal decoction of Anemarrhena Bounge is potentially effective in patients with resistance to ATDs and is a therapeutic avenue warranting future exploration [5].…”

Section: Commentsmentioning

confidence: 99%

Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

Diack¹,

Ndiaye²,

Sène³

et al. 2020

OJEMD

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Background: Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves' disease. Case 1: A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave's orbitopathy. TSH levels were low (0.005 mIU/ml; N = 0.27-4.20) and fT4 elevated (60 pmol/L; N = 12-22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves' disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol's solution was performed successfully. Case 2: A 22-year-old woman was referred for continued management of Graves' disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL; N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12-22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient's symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day

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“…2 In patients with severe hyperthyroidism, in cases of thyroid storm and in cases where ATD cannot be used due to side effects or ineffectiveness, plasmapheresis therapy can be used to provide euthyroidism before permanent treatment. [3][4][5][6][7][8] Therapeutic plasma exchange (TPE) is the process of replacing patient plasma with albumin or fresh frozen plasma (FFP). During this treatment, thyroid hormones, high molecular weight substances, autoantibodies, immune complexes, cytokines, catecholamines and thyroid-binding globulins are also cleared from the patient's blood.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients

SARIDAŞ

TURNA

Aydemir

et al. 2022

Turkish Journal of Internal Medicine

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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 MethodsThe 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.

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

Cited by 9 publications

References 19 publications

Therapeutic plasma exchange for Graves’ disease in pregnancy

Therapeutic plasma exchange for Graves’ disease in pregnancy

Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients

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