Endocrinology and Metabolism Department, Yozgat City Hospital, Yozgat, Turkey.
Endocrinology and Metabolism Department, Amasya University Sabuncuğlu Serefeddin Education and Research Hospital, Amasya, Turkey.
Transfus Apher Sci. 2020 Aug;59(4):102744. doi: 10.1016/j.transci.2020.102744. Epub 2020 Mar 18.
Hyperthyroidism is characterized by excess hormone secretion from the thyroid gland. Anti-thyroid drugs (ATDs), surgery, and radioactive iodine can be used in treatment. Plasmapheresis is a rapid and effective treatment option in cases where rapid euthyroidism is needed to be obtained due to complications of thyrotoxicosis and major adverse effects of ATDs.
We present patients receiving plasmapheresis to provide immediate euthyroidism due to severe hyperthyroidism, adverse effects of ATDs, or non-thyroid surgery from January 2012 to December 2016.
This study included 18 patients. The etiology of hyperthyroidism was TDG in seven patients, TDMNG in two, TA in two, TMNG in four, and one patient had AIT. Plasmapheresis was performed to achieve euthyroidism before surgery in two patients. The mean plasmapheresis session was 5.35. The mean number of sessions needed for patients with TDG and TDMNG was 4, whereas it was 6.5 for patients with TA and TMNG (p = 0.07). The decrease of mean free thyroxine and free triiodothyronine were 57 % and 73 %, respectively (p < 0.001). After plasmapheresis, total thyroidectomy was performed in 14 patients. Euthyroidism was achieved with RAI in one patient and with medical therapy in three patients.
Plasmapheresis therapy is a reliable and effective treatment option for patients who cannot use ATDs because of their adverse events and those with hyperthyroidism that does not resolve with these drugs, or to achieve euthyroidism before total thyroidectomy, RAI or non-thyroid emergency surgery. However, it cannot be used widely because it is expensive and invasive.
甲状腺功能亢进症的特征是甲状腺激素分泌过多。抗甲状腺药物（ATD）、手术和放射性碘可用于治疗。在因甲状腺毒症的并发症和 ATD 的严重不良反应而需要迅速获得甲状腺功能正常时，血浆置换是一种快速有效的治疗选择。
我们介绍了因严重甲状腺功能亢进症、ATD 的不良反应或非甲状腺手术而接受血浆置换以立即获得甲状腺功能正常的患者，这些患者的病例为 2012 年 1 月至 2016 年 12 月。
本研究共纳入 18 例患者。7 例患者的甲状腺功能亢进症病因是甲状腺球蛋白（TDG），2 例是甲状腺髓样癌（TDMNG），2 例是毒性多结节性甲状腺肿（TA），4 例是多结节毒性甲状腺肿（TMNG），1 例是自身免疫性甲状腺炎（AIT）。为了在手术前实现甲状腺功能正常，2 例患者接受了血浆置换。平均血浆置换疗程为 5.35 次。TDG 和 TDMNG 患者需要的平均疗程为 4 次，而 TA 和 TMNG 患者则为 6.5 次（p = 0.07）。游离甲状腺素和游离三碘甲状腺原氨酸的平均降幅分别为 57%和 73%（p < 0.001）。血浆置换后，14 例患者进行了全甲状腺切除术。1 例患者接受放射性碘治疗，3 例患者接受药物治疗后甲状腺功能正常。
对于因不良反应而不能使用 ATD 的患者，或对于药物治疗不能缓解的甲状腺功能亢进症患者，或对于需要在全甲状腺切除术、放射性碘或非甲状腺急症手术前获得甲状腺功能正常的患者，血浆置换治疗是一种可靠有效的治疗选择。然而，由于其昂贵和有创性，它不能被广泛应用。
