Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study
Background and aims Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxic...
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| Veröffentlicht in: | Journal of clinical apheresis 2021-10, Vol.36 (5), p.759-765 |
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| creator | Builes‐Montaño, Carlos E. Rodriguez‐Arrieta, Luis A. Román‐González, Alejandro Prieto‐Saldarriaga, Carolina Alvarez‐Payares, Jose C. Builes‐Barrera, Carlos A. Arango‐Toro, Clara M. |
| description | Background and aims
Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.
Methods
We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment.
Results
Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P |
| doi_str_mv | 10.1002/jca.21927 |
| format | Article |
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Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.
Methods
We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment.
Results
Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta‐blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients.
Conclusions
Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non‐thyroid surgery. It is limited by its cost and the need for highly specialized resources.</description><identifier>ISSN: 0733-2459</identifier><identifier>EISSN: 1098-1101</identifier><identifier>DOI: 10.1002/jca.21927</identifier><identifier>PMID: 34273178</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adolescent ; Adult ; anti‐thyroid agents ; Apheresis ; Child ; Female ; Humans ; hyperthyroidism ; Latin America ; Male ; Middle Aged ; plasmapheresis ; Plasmapheresis - adverse effects ; Plasmapheresis - methods ; Propranolol - therapeutic use ; Retrospective Studies ; Thyroid gland ; Thyroid Hormones - blood ; thyrotoxicosis ; Thyrotoxicosis - blood ; Thyrotoxicosis - therapy ; Young Adult</subject><ispartof>Journal of clinical apheresis, 2021-10, Vol.36 (5), p.759-765</ispartof><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-dc60f9fc045594178bca3b8805fcebb8ea61c1c2a87ac975488211a8aa8ae03e3</citedby><cites>FETCH-LOGICAL-c3537-dc60f9fc045594178bca3b8805fcebb8ea61c1c2a87ac975488211a8aa8ae03e3</cites><orcidid>0000-0002-2418-6159</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjca.21927$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjca.21927$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34273178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Builes‐Montaño, Carlos E.</creatorcontrib><creatorcontrib>Rodriguez‐Arrieta, Luis A.</creatorcontrib><creatorcontrib>Román‐González, Alejandro</creatorcontrib><creatorcontrib>Prieto‐Saldarriaga, Carolina</creatorcontrib><creatorcontrib>Alvarez‐Payares, Jose C.</creatorcontrib><creatorcontrib>Builes‐Barrera, Carlos A.</creatorcontrib><creatorcontrib>Arango‐Toro, Clara M.</creatorcontrib><title>Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study</title><title>Journal of clinical apheresis</title><addtitle>J Clin Apher</addtitle><description>Background and aims
Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.
Methods
We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment.
Results
Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta‐blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients.
Conclusions
Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non‐thyroid surgery. It is limited by its cost and the need for highly specialized resources.</description><subject>Adolescent</subject><subject>Adult</subject><subject>anti‐thyroid agents</subject><subject>Apheresis</subject><subject>Child</subject><subject>Female</subject><subject>Humans</subject><subject>hyperthyroidism</subject><subject>Latin America</subject><subject>Male</subject><subject>Middle Aged</subject><subject>plasmapheresis</subject><subject>Plasmapheresis - adverse effects</subject><subject>Plasmapheresis - methods</subject><subject>Propranolol - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Thyroid gland</subject><subject>Thyroid Hormones - blood</subject><subject>thyrotoxicosis</subject><subject>Thyrotoxicosis - blood</subject><subject>Thyrotoxicosis - therapy</subject><subject>Young Adult</subject><issn>0733-2459</issn><issn>1098-1101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtKAzEUBuAgiq2XhS8gATe6mDaXSSdxV4pXCm7qesikZ-iUmWZMMmp3PoLP6JMYbXUhCIEDh4-fkx-hE0oGlBA2XBo9YFSxbAf1KVEyoZTQXdQnGecJS4XqoQPvl4QQpbjYRz2esozTTPbRfLYAp1voQmVwW2vf6DZuwFcel9bhsAAcHOjQwCpgW8bF2tlgXytjo7nEY-wgOOtbMKF6Btx0dag-3t5N9OCwD918fYT2Sl17ON7OQ_R4fTWb3CbTh5u7yXiaGC54lszNiJSqNCQVQqXxvMJoXkhJRGmgKCToETXUMC0zbVQmUikZpVrq-IBw4IfofJPbOvvUgQ95U3kDda1XYDufMyGYkimTItKzP3RpO7eK10UlqUyJEGlUFxtl4g-9gzJvXdVot84pyb-qz2P1-Xf10Z5uE7uigfmv_Ok6guEGvFQ1rP9Pyu8n403kJ-82j80</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Builes‐Montaño, Carlos E.</creator><creator>Rodriguez‐Arrieta, Luis A.</creator><creator>Román‐González, Alejandro</creator><creator>Prieto‐Saldarriaga, Carolina</creator><creator>Alvarez‐Payares, Jose C.</creator><creator>Builes‐Barrera, Carlos A.</creator><creator>Arango‐Toro, Clara M.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2418-6159</orcidid></search><sort><creationdate>202110</creationdate><title>Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study</title><author>Builes‐Montaño, Carlos E. ; Rodriguez‐Arrieta, Luis A. ; Román‐González, Alejandro ; Prieto‐Saldarriaga, Carolina ; Alvarez‐Payares, Jose C. ; Builes‐Barrera, Carlos A. ; Arango‐Toro, Clara M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-dc60f9fc045594178bca3b8805fcebb8ea61c1c2a87ac975488211a8aa8ae03e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>anti‐thyroid agents</topic><topic>Apheresis</topic><topic>Child</topic><topic>Female</topic><topic>Humans</topic><topic>hyperthyroidism</topic><topic>Latin America</topic><topic>Male</topic><topic>Middle Aged</topic><topic>plasmapheresis</topic><topic>Plasmapheresis - adverse effects</topic><topic>Plasmapheresis - methods</topic><topic>Propranolol - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Thyroid gland</topic><topic>Thyroid Hormones - blood</topic><topic>thyrotoxicosis</topic><topic>Thyrotoxicosis - blood</topic><topic>Thyrotoxicosis - therapy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Builes‐Montaño, Carlos E.</creatorcontrib><creatorcontrib>Rodriguez‐Arrieta, Luis A.</creatorcontrib><creatorcontrib>Román‐González, Alejandro</creatorcontrib><creatorcontrib>Prieto‐Saldarriaga, Carolina</creatorcontrib><creatorcontrib>Alvarez‐Payares, Jose C.</creatorcontrib><creatorcontrib>Builes‐Barrera, Carlos A.</creatorcontrib><creatorcontrib>Arango‐Toro, Clara M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical apheresis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Builes‐Montaño, Carlos E.</au><au>Rodriguez‐Arrieta, Luis A.</au><au>Román‐González, Alejandro</au><au>Prieto‐Saldarriaga, Carolina</au><au>Alvarez‐Payares, Jose C.</au><au>Builes‐Barrera, Carlos A.</au><au>Arango‐Toro, Clara M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study</atitle><jtitle>Journal of clinical apheresis</jtitle><addtitle>J Clin Apher</addtitle><date>2021-10</date><risdate>2021</risdate><volume>36</volume><issue>5</issue><spage>759</spage><epage>765</epage><pages>759-765</pages><issn>0733-2459</issn><eissn>1098-1101</eissn><abstract>Background and aims
Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first‐line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second‐line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.
Methods
We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment.
Results
Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta‐blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients.
Conclusions
Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non‐thyroid surgery. It is limited by its cost and the need for highly specialized resources.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34273178</pmid><doi>10.1002/jca.21927</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2418-6159</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adult anti‐thyroid agents Apheresis Child Female Humans hyperthyroidism Latin America Male Middle Aged plasmapheresis Plasmapheresis - adverse effects Plasmapheresis - methods Propranolol - therapeutic use Retrospective Studies Thyroid gland Thyroid Hormones - blood thyrotoxicosis Thyrotoxicosis - blood Thyrotoxicosis - therapy Young Adult |
| title | Therapeutic plasmapheresis for the treatment of thyrotoxicosis: A retrospective multi‐center study |
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