Preoperative Therapeutic Plasmapheresis In Thyrotoxic Patients Who Did Not Effectively Treated With Antithyroid Drugs, Iodine And Corticosteroid

Abstract

Introduction: Preoperative treatment options in thyrotoxic patients are antithyroid drugs,potassium iodide, beta blockers and corticosteroids. Sometimes these treatment regimens havenot been so successful for the patients to make them ready for the operation. So we thought thatplasmapheresis (PP) could be an alternative to these treatments. Methods: Two thyrotoxic patients with Graves’ disease and one patient with toxic multinodulargoiter were included in the study. All patients were candidates to surgical operation due to thecontraindication of other medical treatment choices. On admission, all patients had severeuncontrolled hyperthyroidism. In order to prepare our patients to operation, all the patients weregiven beta blockers and inorganic potassium iodide and corticosteroid at first but disease controlcould not be achieved in terms of thyrotoxicosis. So PP was performed at an average of 3 to 5sessions. Results: After PP, all patients’ thyroid hormone concentrations were significantly reduced. Onepatient had an anaphylactic reaction during 3th session of PP. Total thyroidectomy wasperformed to all patients without any complications.Conclusions: We concluded that PP could be used as an alternative therapeutic option in thepreoperative management of severe thyrotoxic patients.

Keywords

• Thyrotoxicosis
• plasmapheresis
• thyroid surgery