De Rosa G, Testa A, Menichella G, Cecchini L, Cavallaro A, Mantovani M, Mango G
Department of Endocrinology, Università, Cattolica del Sacro Cuore, Rome, Italy.
Haematologica. 1991 Mar;76 Suppl 1:72-4.
Surgery, the treatment of choice for hyperthyroidism due to nodular goiter, requires an euthyroid state, which is generally achieved with thionamides. Leukopenia is the most serious toxic effect of thionamides, and it causes controindication. We report a 50-year old woman with severe hyperthyroidism and leukopenia, in whom an euthyroid state before thyroidectomy was obtained with the use of therapeutic plasmapheresis. This procedure was carried out immediately before surgery using an intermittent flow separator; three sessions removed a total of 6,300 cc of plasma. Plasmapheresis caused a rapid reduction of both total and free thyroid hormone levels. Thyroidectomy was performed without any complications. Plasmapheresis can be considered a valid and safe method to prepare hyperthyroid patients for thyroidectomy when other therapies are ineffective or counterindicated.
手术是结节性甲状腺肿所致甲状腺功能亢进的首选治疗方法，需要甲状腺功能正常状态，这通常通过硫代酰胺类药物来实现。白细胞减少是硫代酰胺类药物最严重的毒性作用，可导致禁忌。我们报告了一名50岁患有严重甲状腺功能亢进和白细胞减少的女性，通过治疗性血浆置换在甲状腺切除术前达到了甲状腺功能正常状态。该操作在手术前立即使用间歇流分离器进行；三次治疗共去除6300毫升血浆。血浆置换导致总甲状腺激素和游离甲状腺激素水平迅速降低。甲状腺切除术顺利完成，无任何并发症。当其他治疗无效或禁忌时，血浆置换可被视为一种为甲状腺功能亢进患者进行甲状腺切除术做准备的有效且安全的方法。
