Agranulocytosis is an uncommon but very serious complication during treatment with thyrostatic. In case of severe hyperthyroidism removal of circulating thyroid hormones by plasmapheresis may be an effective therapeutic option.
We present the therapeutic difficulties and successful treatment with preoperative plasmapheresis in 63-year-old female patient with severe hyperthyroidism in the course of toxic nodular goiter and agranulocytosis, which occurred after 3 weeks of taking thiamazole. We modified and applied the treatment with propylthiouracil and lithium carbonate during hospitalization in the Department of Endocrinology. In consequence of using recombinant granulocytecolony stimulating factor we achieved normalization of neutrophils in the blood. We have decided to thyroidectomy as a life-saving operation because of difficulties in obtaining euthyrosis during the current treatment. We gave organic iodine and conducted two plasmapheresis treatments to give a reduction in the concentration of free thyroid hormones. Plasmapheresis in the perioperative period may cause excessive bleeding during surgery. The potential deficiency of coagulation factors we completed using fresh frozen plasma (FFP). The patient underwent with no complications total thyroidectomy.