Therapeutic Plasmapheresis in Preparation of Toxic Multinodular Goiter for Surgery

Plasmapheresis is an alternative way of removing excess thyroid hormones from circulation to control the signs and symptoms of hyperthyroidism. The purpose of this report was to determine the effectiveness of plasmapheresis in rapid preparation of toxic multinodular goiter for thyroid surgery. The indications for plasmapheresis were propylthiouracil related ANCA(+) panniculitis and ineffective control of hyperthyroidism with methimazole. Thyroid hormone levels only moderately decreased after 7 sessions of plasmapheresis. She underwent surgery with beta-blocker and dexamethasone treatment to avoid thyroid storm in the perioperative period. Surgery was performed uneventfully. Plasmapheresis can be considered a safe and effective method to prepare patients with thyrotoxicosis for surgery when treatment is contraindicated or failed.