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Open AccessCase Report

Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis

1
Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc Av.19, 25-319 Kielce, Poland
2
Endocrinology Clinic, Holycross Cancer Center, S. Artwińskiego St. 3, 25-734 Kielce, Poland
3
Department of Surgical Oncology, Holycross Cancer Center S. Artwińskiego St. 3, 25-734 Kielce, Poland
4
Surgical Pathology, Holycross Cancer Center, S. Artwińskiego St. 3, 25-734 Kielce, Poland
5
Regional Blood Donation and Transfusion Center in Kielce, Jagiellońska St. 66, 25-734 Kielce, Poland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Medicina 2020, 56(6), 290; https://doi.org/10.3390/medicina56060290
Received: 11 May 2020 / Revised: 6 June 2020 / Accepted: 9 June 2020 / Published: 12 June 2020
(This article belongs to the Section Endocrinology)
Agranulocytosis is a rare but very serious complication of thyrostatic therapy. In severe hyperthyroidism, the removal of circulating thyroid hormones by plasmapheresis may be an effective therapeutic option. This report describes the therapeutic difficulties and successful preoperative treatment with plasmapheresis in a 63-year-old patient admitted to the Endocrinology Clinic with severe hyperthyroidism, during the course of giant toxic nodular goiter and agranulocytosis, which occurred after 2 weeks of taking methimazole. During hospitalization, methimazole treatment was discontinued and therapy with steroids, a beta blocker, propylthiouracil, Lugol’s solution, lithium carbonate, and antibiotics were initiated. Granulocyte colony growth stimulating factor was also used to resolve agranulocytosis. Due to the failure to achieve euthyreosis using this approach, we decided to conduct thyroid surgery, as a life-saving action, after preparation of the patient by plasmapheresis. Two plasmapheresis procedures were performed, resulting in a decrease in the concentration of free thyroid hormones. Total thyroidectomy was performed and there were no complications during surgery. We conclude that plasmapheresis may be considered as an effective alternative treatment option for the preparation of patients with hyperthyroidism for surgery, when the clinical situations prevent the use of conventional treatments for hyperthyroidism and when immediate life-saving surgery is necessary. View Full-Text
Keywords: agranulocytosis; plasmapheresis; thyrotoxicosis; hyperthyroidism; thyroidectomy agranulocytosis; plasmapheresis; thyrotoxicosis; hyperthyroidism; thyroidectomy
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Barwinek, K.; Gąsior-Perczak, D.; Trepka, S.; Szczodry, A.; Kopczyński, J.; Sitarz-Żelazna, Z.; Kowalska, A. Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis. Medicina 2020, 56, 290.

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