April - June 2011, Volume 7, Issue 2

Sezer A, Guldiken S, Turgut B, Irfanoglu ME

The Management of Thyrotoxicosis by TherapeuticPlasma Exchange in Patients Complicated with Antithyroid Drugs

Acta Endo (Buc) 2011, 7 (2): 239-248
doi: 10.4183/aeb.2011.239

Objective. Antithyroid drugs, surgical excision, and radiation therapy with 131I are the common treatment modalities thyrotoxicosis. The medical treatment of\r\nthyrotoxicosis has approximately 0.35% serious complications which consist of agranulocytosis, liver necrosis and failure. Therapeutic plasma exchange is an effective\r\npreoperative preparation method in thyrotoxicosis patients who are candidates for surgery and unable to manage an euthyroid state with medical treatment.\r\nPatients and Methods. This study was constructed between 2002-2009 in 9 patients who were resistant or had complications with medical treatment of thyrotoxicosis. The\r\ntherapeutic plasma exchange procedures were performed with discontinuous flow cell separator devices.\r\nResults. Seven patients were females and 2 patients were males. The mean age was 51.22 years (32-78 years). The mean duration of the disease was 35.4 months (3-120 months). The patients underwent 3.3 (2-6 sessions) session of therapeutic plasma exchange before surgery. The mean volume of\r\nplasma exchange was 10549 mL (7150-18372 mL). The plasma is exchanged with %10 albumin and/or fresh frozen plasma. The\r\ncomplication rate was 22% during therapeutic plasma exchange. Four patients underwent near total thyroidectomy and five patients underwent total thyroidectomy. The mortality rate was zero. Neck hematoma causing acute\r\nrespiratory compromise and requiring urgent evacuation developed in one patient.\r\nConclusions. Total plasma exchange is an effective and safe procedure in preoperative preparation of the patients with thyrotoxicosis who were resistant or complicated with\r\nantithyroid drug in which a high level of concern and steady supervision is mandatory to prevent life threatening preoperative and postoperative complications.

Keywords: thyrotoxicosis, therapeutic plasma exchange, antithyroid drugs, surgery

Correspondence: Atakan Sezer, MD, Department of General Surgery, Faculty of Medicine, Trakya University, Edirne, 22030, Turkey, Email: atakansezer@hotmail.com, Phone: +90 0532 422 38 40, Fax: +90 284 2352730