Plasmapheresis in thyrotoxicosis: a single-center case series

Area of Science:

• Endocrinology
• Nephrology
• Internal Medicine

Background:

• Hyperthyroidism and thyroid storm often require multimodal treatment, but drug ineffectiveness or toxicity can complicate management.
• Standard therapies for thyrotoxicosis include antithyroid drugs, iodine, beta-blockers, and corticosteroids, which may not be suitable for all patients.
• Plasmapheresis is explored as an alternative therapeutic strategy for refractory or complicated hyperthyroid cases.

Observation:

• A case series involving three young African patients with Graves' disease is presented.
• Patients experienced drug ineffectiveness, drug-induced agranulocytosis, and thyroid storm with multi-organ failure.
• All three patients underwent therapeutic plasma exchange (TPE) sessions.

Findings:

• TPE led to a significant reduction in plasma thyroid hormone levels.
• TPE effectively decreased anti-thyroid antibodies.
• The apheresis procedure provided a crucial window for subsequent total thyroidectomy.

Implications:

• Therapeutic plasma exchange demonstrates efficiency and safety in the preoperative management of thyrotoxicosis.
• This apheresis modality can be a valuable option for patients with severe hyperthyroidism unresponsive to or intolerant of conventional therapies.
• The findings support the integration of TPE into the treatment algorithm for complex hyperthyroid cases, particularly those with thyroid storm.