Yasemin Ateş TÜTÜNCÜ, Dilek BERKER, Serhat IŞIK, Ufuk ÖZOĞUZ, Serdar GÜLER, Yusuf AYDIN

Anti-Tiroid İlaçlar, İyot ve Kortikosteroid Tedavinin Etkin Olmadığı Tirotoksik Hastalarda Preoperatif Plazmaferez Tedavisi

Giriş: Tirotoksik hastalarda preoperative tedavi seçenekleri antitiroid ilaçlar, potasyum iyodür,beta blokerler ve kortikosteroidlerdir. Ancak zaman zaman bu tedavi modaliteleri hastaya ötiroidhale getirmekte yetersiz kalabilmekteidr. Böyle durumlarda plazmaferez uygulaması alternativebir tedavi yöntemi olarak hatırlanmalıdır.Metod: Üç tirotoksik hasta bu çalışmaya dahil edildi. Hastaların ikisine Graves Hastalığı birineise toksik multinodüler guatr tanısı konulmuştu. Hastaların hepsinde diğer medikal tedaviseçenekleri kontrendike olması nedeniyle cerrahi tedavi tercih edildi. Başvuru sırasında bütünhastaların kontrol altına alınamayan ciddi hipertiroidizmi mevcuttu. Bu nedenle hastalarıoperasyona hazırlayabilmek için bütün hastalara beta bloker, inorganic potasyum iyodür, vekortikosteroid tedavisi başlandı ancak hastalarda ötiroidizm sağlanamadı bunun üzerine hastalaraortalama 3-5 seans plazmaferez uygulandı.Sonuçlar: Plazmaferez sonrası hastaların hepsinde tiroid hormon konsantrasyonları anlamlıolarak azaldı. Bir hastada 3. seans sırasında anaflaktik reaksiyon gelişti. Hastaların hepsindetotal tiroidektomi başarılı bir şekilde uygulandı ve hiçbir komplikasyon gelişmedi.Tartışma : Plazmaferez ciddi tirotoksik hastaları operasyona hazırlama aşamasında diğer tedaviseçeneklerine alternatif bir yöntemdir

Anahtar Kelimeler:

tirotoksikoz, plazmaferez, tiroid cerrahisi

Preoperative Therapeutic Plasmapheresis In Thyrotoxic Patients Who Did Not Effectively Treated With Antithyroid Drugs, Iodine And Corticosteroid

Introduction: Preoperative treatment options in thyrotoxic patients are antithyroid drugs,potassium iodide, beta blockers and corticosteroids. Sometimes these treatment regimens havenot been so successful for the patients to make them ready for the operation. So we thought thatplasmapheresis (PP) could be an alternative to these treatments. Methods: Two thyrotoxic patients with Graves’ disease and one patient with toxic multinodulargoiter were included in the study. All patients were candidates to surgical operation due to thecontraindication of other medical treatment choices. On admission, all patients had severeuncontrolled hyperthyroidism. In order to prepare our patients to operation, all the patients weregiven beta blockers and inorganic potassium iodide and corticosteroid at first but disease controlcould not be achieved in terms of thyrotoxicosis. So PP was performed at an average of 3 to 5sessions. Results: After PP, all patients’ thyroid hormone concentrations were significantly reduced. Onepatient had an anaphylactic reaction during 3th session of PP. Total thyroidectomy wasperformed to all patients without any complications.Conclusions: We concluded that PP could be used as an alternative therapeutic option in thepreoperative management of severe thyrotoxic patients

Keywords:

Thyrotoxicosis, plasmapheresis, thyroid surgery,

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