Builes-Montaño Carlos E, Rodriguez-Arrieta Luis A, Román-González Alejandro, Prieto-Saldarriaga Carolina, Alvarez-Payares Jose C, Builes-Barrera Carlos A, Arango-Toro Clara M
Internal Medicine Department, Endocrinology and Metabolism Section, School of Medicine, Universidad de Antioquia, Medellin, Colombia.
Endocrinology Department, Hospital Pablo Tobón Uribe, Medellin, Colombia.
J Clin Apher. 2021 Oct;36(5):759-765. doi: 10.1002/jca.21927. Epub 2021 Jul 17.
Thyroid storm and severe thyrotoxicosis remain among the most frequent endocrine emergencies, and first-line hyperthyroidism treatment is not always an option. Since the first report in 1970, plasmapheresis is a second-line treatment for severe or otherwise untreatable thyrotoxicosis when rapid euthyroidism is desired.
We present a retrospective study of the experience in treating thyrotoxicosis with plasmapheresis between 2012 and 2020 in two specialized centers in Colombia. We register the demographic and clinical characteristic and compare the thyroid hormones and other biochemical measurements before and after treatment.
Data from 19 patients was obtained, 58% female with a median age of 35 years (IQR 23.5), and most of them with Graves' disease. The most frequent indication for plasmapheresis was thyroid storm. A median of 4 (IQR 2) sessions lead to a significant reduction in FT4 (P .0001) and TT3 (P < .0003) with a nonsignificant decrease in beta-blocker (P .7353) dose, no change in hepatic enzymes, and no adverse events. After plasmapheresis, thyroidectomy was performed in 10 patients.
Plasmapheresis is an effective and safe treatment option for reducing circulating thyroid hormones in severe thyrotoxicosis when other forms of treatment are contraindicated or in case of urgent thyroid and non-thyroid surgery. It is limited by its cost and the need for highly specialized resources.
甲状腺风暴和严重甲状腺毒症仍是最常见的内分泌急症，一线甲亢治疗并非总是可行。自1970年首次报道以来，血浆置换是在需要快速实现甲状腺功能正常时用于治疗严重或其他难以治疗的甲状腺毒症的二线治疗方法。
我们对2012年至2020年期间在哥伦比亚两个专科中心用血浆置换治疗甲状腺毒症的经验进行了回顾性研究。我们记录了人口统计学和临床特征，并比较了治疗前后的甲状腺激素和其他生化指标。
获得了19例患者的数据，其中58%为女性，中位年龄35岁（四分位间距23.5），大多数患有格雷夫斯病。血浆置换最常见的指征是甲状腺风暴。中位4次（四分位间距2）治疗导致游离甲状腺素（FT4）（P<0.0001）和总三碘甲状腺原氨酸（TT3）（P<0.0003）显著降低，β受体阻滞剂剂量无显著降低（P = 0.7353），肝酶无变化，且无不良事件。血浆置换后，10例患者接受了甲状腺切除术。
当其他治疗形式禁忌或在紧急甲状腺及非甲状腺手术情况下，血浆置换是降低严重甲状腺毒症患者循环甲状腺激素的一种有效且安全的治疗选择。其局限性在于成本高且需要高度专业化的资源。
