Clotilde Saïe1, Cécile Ghander1, Samir Saheb2, Christel Jublanc3, Denis Lemesle4, Charlotte Lussey-Lepoutre5, Laurence Leenhardt1, Fabrice Menegaux6, Christophe Tresallet7, Camille Buffet1. 1. Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France. 2. Apheresis Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France. 3. Department of Endocrinology, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France. 4. Department of Anaesthesia, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France. 5. Nuclear Medicine Department, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Inserm U970, Paris, France. 6. Department of Surgery, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France. 7. Department of Surgery, Avicennes Hospital, Paris, France.
Abstract
INTRODUCTION: Hyperthyroid patients who are unresponsive to medical treatment remain a challenging clinical problem. OBJECTIVE: The goal of our study was to evaluate the use of therapeutic plasma exchange (TPE) in hyperthyroid patients and their outcome after TPE. METHOD: We retrospectively reviewed 22 patients who underwent TPE for refractory thyrotoxicosis in our institution: 13 with Graves' disease, 7 with amiodarone-induced thyrotoxicosis (AIT), 1 with toxic goiter, and 1 pregnant patient with familial nonautoimmune thyrotoxicosis. RESULTS: Before TPE, all patients had severe hyperthyroidism, and antithyroid drugs were either contraindicated or not sufficiently effective to restore euthyroidism promptly. After all the TPEs, free T4 (fT4) decreased significantly by 48% (p = 0.001) and fT3 by 52% (p = 0.0001). The median number of TPE sessions per patient was 4 (range: 1-10). There were no complications during the 91 TPE sessions. Total thyroidectomy with no severe side effects was performed on 16/22 patients and 1 other patient was treated with radioactive iodine. One patient died from severe thyrotoxicosis during medical care. The remaining 4 patients were followed up without any radical treatment. For all 7 patients with AIT, iterative TPE led to a significant clinical improvement, and amiodarone was continued for 1 patient. Available treatments were continued between TPE sessions (cholestyramine for 13 patients [60%] and glucocorticoids for 16 patients [73%]). CONCLUSION: TPE allowed a safe decrease of 50% in thyroid hormone levels, and it should be considered for refractory hyperthyroid patients when medical treatments are contraindicated or have failed to restore euthyroidism, irrespective of the etiology of the thyrotoxicosis.
INTRODUCTION: Hyperthyroid patients who are unresponsive to medical treatment remain a challenging clinical problem. OBJECTIVE: The goal of our study was to evaluate the use of therapeutic plasma exchange (TPE) in hyperthyroid patients and their outcome after TPE. METHOD: We retrospectively reviewed 22 patients who underwent TPE for refractory thyrotoxicosis in our institution: 13 with Graves' disease, 7 with amiodarone-induced thyrotoxicosis (AIT), 1 with toxic goiter, and 1 pregnant patient with familial nonautoimmune thyrotoxicosis. RESULTS: Before TPE, all patients had severe hyperthyroidism, and antithyroid drugs were either contraindicated or not sufficiently effective to restore euthyroidism promptly. After all the TPEs, free T4 (fT4) decreased significantly by 48% (p = 0.001) and fT3 by 52% (p = 0.0001). The median number of TPE sessions per patient was 4 (range: 1-10). There were no complications during the 91 TPE sessions. Total thyroidectomy with no severe side effects was performed on 16/22 patients and 1 other patient was treated with radioactive iodine. One patient died from severe thyrotoxicosis during medical care. The remaining 4 patients were followed up without any radical treatment. For all 7 patients with AIT, iterative TPE led to a significant clinical improvement, and amiodarone was continued for 1 patient. Available treatments were continued between TPE sessions (cholestyramine for 13 patients [60%] and glucocorticoids for 16 patients [73%]). CONCLUSION: TPE allowed a safe decrease of 50% in thyroid hormone levels, and it should be considered for refractory hyperthyroid patients when medical treatments are contraindicated or have failed to restore euthyroidism, irrespective of the etiology of the thyrotoxicosis.
Authors: Rebecca S Bahn Chair; Henry B Burch; David S Cooper; Jeffrey R Garber; M Carol Greenlee; Irwin Klein; Peter Laurberg; I Ross McDougall; Victor M Montori; Scott A Rivkees; Douglas S Ross; Julie Ann Sosa; Marius N Stan Journal: Thyroid Date: 2011-04-21 Impact factor: 6.568