Therapeutic plasmapheresis in thyrotoxic patients

Purpose For the treatment of thyrotoxicosis, alternative treatment modalities may be necessary if anti-thyroid drugs cannot be used due to side effects, inefficiencies, or there is a need to start a rapid action such as thyroid storm. By using therapeutic plasma exchange (TPE), it is possible to effectively and rapidly remove the increased thyroid hormones. We evaluated our results and experience on a rapid, effective, and reliable alternative treatment modality in thyrotoxic patients. Methods TPE was performed in 46 thyrotoxic patients at the Adult Therapeutic Apheresis Center. Results Forty six patients with a median age of 30 years (interquartile range [IQR] 30–50) were assessed. In 40 (87%) of the cases, the diagnosis was Graves’ disease. The other causes of thyrotoxicosis were amiodarone-induced thyrotoxicosis ( n = 4) and toxic nodular goiter ( n = 2). The median and IQR of fT3 values in patients before TPE were 9.9 (6.5-16.8) pg/mL ( N : 2.3–4.2) and the median and IQR of fT4 values were 2.9 (2.3–4.1) ng/dL ( N : 0.74–1.52). When the procedure was terminated, the median and IQR of fT3 values in patients were 4.0 (3.1–5.2) pg/mL and the median and IQR fT4 values were 1.6 (1.4–2.0) ng/dL. The decrease in both free thyroid hormones was found to be statistically significant ( p