Double filtration plasmapheresis in antithyroid drug-refractory Graves disease with a massive goiter

We report a case of double filtration plasmapheresis (DFPP) performed in medication-resistant Graves disease (GD) with a massive goiter. A 19-year-old female was diagnosed with GD and initially demonstrated poor medication compliance. She presented with loss of consciousness from hypoxemia due to goiter-related tracheal narrowing. Despite inpatient drug therapy, the thyroid hormone levels remained high. We performed DFPP to control thyrotoxicosis before proceeding with thyroidectomy. After 4 sessions, thyroid hormone levels improved, enabling total thyroidectomy. GD with a large goiter may be refractory to medical therapy. In such cases, DFPP can improve thyroid hormone levels.