Effectiveness and safety of therapeutic plasma exchange as a bridging therapy before surgery in patients with medically refractory hyperthyroidism

Purpose: The aim of this study is to evaluate the cost and effectiveness of therapeutic plasma exchange (TPE) treatment applied in patients with hyperthyroidism in whom clinical and biochemical control cannot be achieved with antithyroid drug therapy or who cannot tolerate medical treatment due to severe drug-related adverse effects.Materials and Methods: This single-center retrospective cohort study included hyperthyroidism patients who underwent TPE to achieve preoperative euthyroidism due to resistance to antithyroid drug therapy or severe adverse drug reactions were evaluated. Thyroid function tests and autoantibody levels were compared before and after plasmapheresis.Results: The mean age of the 22 patients included in the study was 38.6 ± 15.3. Graves' disease was detected in 72% of the patients, and toxic multinodular goiter in 28%. The indications for plasmapheresis were drug resistance (90.9%), elevated AST–ALT levels (4.5%), and neutropenia (4.5%). A comparison of the biochemical parameters before and after plasmapheresis demonstrated a significant reduction in sT3 and sT4 levels. In contrast, a significant increase in TSH levels was observed after the procedure. Evaluation of autoimmune markers revealed significant decreases in anti-TG, thyroglobulin, and anti-TPO levels. Conclusion: TPE provides rapid clearance of circulating free thyroid hormones in patients with pharmacotherapy-resistant thyrotoxicosis and represents an effective and safe metabolic stabilization strategy that facilitates safe progression to curative surgery.