Use of Plasmapheresis in the Treatment of Thyrotoxicosis Secondary to Graves' Disease at the National Medical Center 20 de Noviembre ISSSTE: Case Report

Abstract

Thyrotoxicosis refers to the clinical syndrome secondary to excess of circulating thyroid hormones, thyroid storm is an extreme manifestation of thyrotoxicosis, and which can reach 10-30% mortality with treatment depending on the series. This rare but serious complication occurs mainly in patients with Graves' disease (GD) who account for 60% to 80% of cases of hyperthyroidism. Both plasmapheresis/therapeutic plasma exchange (TPE) and emergency surgery have been used to treat thyroid storm in patients who respond poorly to first-line therapeutic measures. We present the case report of three patients with severe disease (GD) managed at the National Medical Center 20 de Noviembre ISSSTE using TPE as a bridge treatment to thyroidectomy, of which the indication for two patients was intolerance to antithyroid drugs and one with intolerance to antithyroid drugs in addition to impending thyroid storm. Between 4-5 sessions of TPE were performed in which there was a decrease in T4L and anti-TSH receptor antibodies (TSH-R-Ab), in addition to significant clinical improvement, which allowed us to perform thyroidectomy safely. Therefore, we consider that TPE is a fast, safe, and effective bridge treatment to surgery, which should be considered in patients with no response or intolerance to thionamide treatment, in centers where TPE and immediate surgery are available.