The purpose of this report was to determine the effectiveness of therapeutic
plasma exchange (TPE) in preoperative preparation of patients with
thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with
thyrotoxicosis and those who prepared surgery with
plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during
antithyroid drug treatment. The indications for
plasmapheresis in all patients with severe
thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to
antithyroid drugs (three patients),
iodine-induced
thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operation (one patient). After TPE, we observed a marked decrease in free
thyroxin (FT3) and free triiodothyronin (FT4) levels; however, the decline in the biochemical values were not statically significant (P > 0.62, P > 0.15). Although both FT3 and FT4 levels remained above the normal limits in two of 11 patients, the signs and symptoms of
thyrotoxicosis improved in all patients and no
thyroid storm observed during the
perioperative period. TPE can be considered a safe and effective alternative to prepare patients with
thyrotoxicosis for surgery when
drug treatment fails or is contraindicated and when emergency surgery is required.