Therapeutic Plasmapheresis in Patients with Thyrotoxicosis. Report of Two Cases

Abstract

Background: Therapeutic plasmapheresis (TPE) in patients with thyrotoxicosis increases the elimination of thyroid hormones and the dilution of the ones remaining in the plasma infusion.Objectives: To describe two cases of patients with thyrotoxicosis, both scheduled for thyroidectomy and who received TPE via a pre-surgical preparation.Methods: Case reports in which the characteristics of the individuals, plasmapheresis time, free thyroxine values during follow-up and successful surgical procedures were described.Results: Two cases are presented. Both patients had agranulocytosis related to the use of methimazole. The first patient presented with Graves’ disease and failed to reduce levels of free thyroxine (FT4) with TPE, even after two sessions. The second case describes a patient with toxic multi-nodular goiter, who had a good response to TPE: after 4 sessions, FT4 decreased by 33%.Conclusion: TPE may be a successful therapeutic alternative as a bridge therapy in thyroidectomy in patients with severe hyperthyroidism that has been refractory to conventional treatment options.