Therapeutic Plasma Exchange in Severe Graves Disease With Hematologic and Hepatic Complications

We report 2 young women with severe Graves thyrotoxicosis in whom antithyroid drugs were contraindicated-one due to drug induced moderate neutropenia and the other due to Graves disease-associated hepatic dysfunction and cytopenia. Both patients presented with life-threatening manifestations of thyrotoxicosis and were unsuitable for immediate surgery or radioiodine therapy. Therapeutic plasma exchange (TPE) was used as a bridging strategy to achieve rapid biochemical control. In the first case, a single session of TPE enabled prompt stabilization for total thyroidectomy. In the second, 3 sessions of TPE led to marked clinical improvement, reversal of hepatic dysfunction and cytopenia, and facilitated successful radioiodine ablation. Neither patient experienced TPE-related complications. These 2 cases highlight the utility of TPE as a safe and effective interim therapy in complicated thyrotoxicosis, allowing timely transition to definitive treatment in high-risk clinical settings where conventional antithyroid therapies are contraindicated.