Endocrine Abstracts

Introduction: Hyperthyroidism is the excessive secretion of hormones by the thyroid gland. Synthetic antithyroid agents, surgery and radioactive iodine are the main available treatments. Plasmapheresis is a rapid and effective treatment option in cases where euthyroidism must be achieved rapidly because of the complications of thyrotoxicosis and the major adverse effects of antithyroid drugs.

Patients and methods: We report a series of 6 patients who underwent plasmapheresis for the treatment of hyperthyroidism. Our aim is to highlight the crucial role played by plasmapheresis in the treatment of hyperthyroidism, especially when other therapeutic options are contraindicated.

Résultats: The average age of our patients was 40, ranging from 22 to 60 years. The etiologies of hyperthyroidism varied between toxic multinodular goitre (2 cases), grave’s disease (3 cases) and Hashitoxicosis (1 case): The indications for plasmapheresis were: Preparation for surgery in 5 cases, with contraindications to antithyroid agents in 4 cases (1 case of pregnancy, 3 cases of hepatic cytolysis) and one case of resistance to antithyroid agents, and severe hashitoxicosis in a 12-day-old pregnancy In our 6 cases, we noted normalization of FT4 levels, and a favorable outcome in 5 patients, with one case of death (hepatic failure).

Discussion and conclusion: In the treatment of hyperthyroidism, synthetic antithyroid drugs, radioactive iodine 1131 and surgery may be options, depending on the etiology. In cases where synthetic antithyroid drugs are insufficient or cannot be prescribed due to major adverse effects, free thyroid hormone levels can be reduced by plasmapheresis prior to radical treatment. Plasmapheresis has been reported in the literature in patients with thyrotoxicosis, and is a reliable and effective therapeutic option. However, it cannot be used on a large scale, as it is costly and invasive. In our study, plasmapheresis proved effective in reducing thyroid hormone levels and preparing patients for appropriate radical treatment.