Therapeutic plasma exchange in hyperthyroidism prior to surgery

Area of Science:

• Endocrinology
• Surgical Oncology
• Internal Medicine

Background:

• Therapeutic plasma exchange (TPE) is an established treatment for reducing thyroid hormones when antithyroid drugs (ATDs) are contraindicated or ineffective.
• Hyperthyroidism management often requires pre-surgical optimization of hormone levels.

Purpose of the Study:

• To evaluate the efficacy and safety of TPE as a pre-surgical treatment for patients with hyperthyroidism.
• To assess the impact of TPE on thyroid hormone levels (FT3, FT4, TSH) before surgical intervention.

Main Methods:

• A retrospective analysis of 11 hyperthyroid patients who underwent TPE prior to surgery between 2008 and 2016.
• Documenting TPE indications, number of sessions, concurrent medications, and adverse events.
• Monitoring changes in FT3, FT4, and TSH levels post-TPE.

Main Results:

• TPE was indicated for ATD contraindication (64%) or insufficient response (36%).
• Statistically significant reductions in FT3 and FT4, and a significant increase in TSH were observed post-TPE (p<0.05).
• Minor adverse events included one allergic reaction and one instance of prolonged prothrombin time without clinical impact.

Conclusions:

• Therapeutic plasma exchange is a reliable and effective method for managing hyperthyroidism prior to surgery.
• TPE offers a valuable alternative for patients with uncontrolled hyperthyroidism when ATDs are not a viable option.
• The study supports broader consideration of TPE in pre-surgical hyperthyroid management beyond current guideline recommendations.