Preoperative preparation of the hyperthyroid patient for thyroidectomy is imperative to avoid perioperative complications due to severe thyrotoxicosis. 24-years old woman was admitted at our clinic for uncontrolled Graves disease. In our case, agranulocytosis introduced by propylthiouracil. Therefore, surgery was the only chance of an effective therapy. In cases when the patient is unresponsive to medical therapy or when such therapy is contraindicated, therapeutic plasma exchange (TPE) could be useful for preparing patients for surgery. After 13th TPE, our patient both FT4 and FT3 levels remained above the normal limits but the sign and symptoms of thyrotoxicosis improved In the literature, number of plasmapheresis sessions done were usually less than 13 except a case of Jod Basedow with 17 sessions We observed a moderate decrease in FT3 and at least decrease in FT4 levels after thirteen session. Total thyroidectomy was performed successfully. In cases when the patient is unresponsive to medical therapy or when such therapy is contraindicated, TPE could be useful for preparing patients with thyrotoxicosis for surgery. It is still unclear why some patients achieve the maximum benefit from TPE, regardless of their etiology. Our patient both FT4 and FT3 levels remained above the normal limits but the sign and symptoms of thyrotoxicosis improved and maybe reduced the risk of thyroid storm in the perioperative period. We continued to use the β-blocker and systemic steroid therapy in order to avoid thyroid storm during the operation and a few days after surgery. These findings suggested that TPE ameliorates the clinical symptoms of thyrotoxicosis rather than thyroid hormone status. It is unclear which elements are responsible for determining patient response to TPE.
20 May 2017 - 23 May 2017