Endocrine Abstracts

A 27-year-old female was attending endocrinology services since April 2024 with graves’ thyrotoxicosis. She remained thyrotoxic despite thionamides, beta blockers, a trial of lithium therapy and corticosteroids. Thyroidectomy was planned. To achieve euthyroid status, pre-operative plasmapheresis was performed. . Three plasma exchanges were on day -6, day -3 and day -1 pre-thyroidectomy (day 0). The initial two procedures used albumin as a replacement fluid and the third used plasma for the last 50% of replacement fluid. Thyroid function tests (TFTs), thyroid-stimulating hormone-receptor antibodies (TRAB), fibrinogen and electrolytes were tested pre and post exchanges. Her TRAB fell from 31.45 to 12.28 IU/l(RR <3.10) pre surgery. Her thyroxine (T4) reduced from 39.3 to 14.7 pmol/l(RR 8-16 pmol/l) and her triiodothyronine (T3) reduced from 21.8 to 8.1 pmol/l(RR 3.8-6 pmol/l). Pre-operatively intravenous hydrocortisone was given. Her peri-operative observations were normal. Post-operatively her thionamide and betablockers were stopped, prednisolone was weaned and levothyroxine was commenced. Post-operative TRAB rose slightly 14.62 IU/l. Plasmapheresis is used in a range of conditions to reduce abnormal antibodies. It has been used in refractory thyrotoxicosis including thyroid storm. This case demonstrated how plasmapheresis can reduce thyroid hormone levels through reducing circulating TRAB and demonstrates its utility in achieving a euthyroid state prior to surgery.