Therapeutic Plasma Exchange for Complicated Hyperthyroidism: A Case Series

Therapeutic plasma exchange is a second-line therapy for severe hyperthyroidism when anti-thyroid drugs (ATD) are contraindicated or ineffective. We report five patients (three males, two females, age range: 30-70 years old): ATD-induced agranulocytosis (n = 2); ATD-induced cholestatic hepatitis (n = 1); refractory hyperthyroidism with large goiter (n = 1); thyroid storm during pregnancy (n = 1). A total of six TPE sessions were performed (five with fresh frozen plasma, one with 5% albumin). Among sessions with quantifiable baseline fT4, levels decreased by a mean of 39.0% per session; two sessions had baseline fT4 above the assay's upper limit of quantification, precluding exact calculation, though both showed reductions of at least 50%. Four patients underwent successful thyroidectomy; one continued medical management. No intraoperative thyroid storms occurred. TPE could be an effective bridging strategy for patients with severe hyperthyroidism and ATD intolerance.