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    THE MANAGEMENT OF THYROTOXICOSIS BY THERAPEUTIC PLASMA EXCHANGE IN PATIENTS COMPLICATED WITH ANTITHYROID DRUGS
    (Editura Acad Romane, 2011) Sezer, A.; Guldiken, S.; Turgut, B.; Irfanoglu, M. E.
    Objective. Antithyroid drugs, surgical excision, and radiation therapy with I-131 are the common treatment modalities thyrotoxicosis. The medical treatment of thyrotoxicosis has approximately 0.35% serious complications which consist of agranulocytosis, liver necrosis and failure. Therapeutic plasma exchange is an effective preoperative preparation method in thyrotoxicosis patients who are candidates for surgery and unable to manage an euthyroid state with medical treatment. Patients and Methods. This study was constructed between 2002-2009 in 9 patients who were resistant or had complications with medical treatment of thyrotoxicosis. The therapeutic plasma exchange procedures were performed with discontinuous flow cell separator devices. Results. Seven patients were females and 2 patients were males. The mean age was 51.22 years (32-78 years). The mean duration of the disease was 35.4 months (3-120 months). The patients underwent 3.3 (2-6 sessions) session of therapeutic plasma exchange before surgery. The mean volume of plasma exchange was 10549 mL (7150-18372 mL). The plasma is exchanged with %10 albumin and/or fresh frozen plasma. The complication rate was 22% during therapeutic plasma exchange. Four patients underwent near total thyroidectomy and five patients underwent total thyroidectomy. The mortality rate was zero. Neck hematoma causing acute respiratory compromise and requiring urgent evacuation developed in one patient. Conclusions. Total plasma exchange is an effective and safe procedure in preoperative preparation of the patients with thyrotoxicosis who were resistant or complicated with antithyroid drug in which a high level of concern and steady supervision is mandatory to prevent life threatening preoperative and postoperative complications.