De la tormenta a la calma: el rol de la plasmaféresis en la estabilización de pacientes con tirotoxicosis de alto riesgo

Abstract

Introduction

Thyrotoxicosis in high-risk patients is a severe condition requiring prompt management, although conventional therapeutic approaches often present limitations. Therapeutic plasmapheresis has emerged as a potential option to achieve rapid clinical stabilization and facilitate a safe transition to definitive treatment by effectively reducing circulating thyroid hormone levels. The objective of this study was to evaluate the safety and efficacy profile of plasmapheresis in patients with high-risk thyrotoxicosis.

Materials and methods

We conducted a retrospective multicenter study with a cohort of 13 patients with high-risk thyrotoxicosis who underwent plasmapheresis due to clinical instability, adverse effects related to antithyroid drugs, or significant cardiovascular comorbidities. Therapeutic success was assessed based on objective clinical improvement and restoration of euthyroidism, determined by hormonal measurements. Adverse events were systematically recorded to evaluate the procedural safety profile.

Results

The median age was 50 years, and 84.6% of patients were women. The median number of plasmapheresis sessions was 3. Normalization of T3 and free T4 levels was achieved in 92.3% of patients. Mild adverse events occurred in 30.8% of cases, none of which required treatment discontinuation. Definitive therapy following plasmapheresis was performed in 76.9% of patients, most commonly total thyroidectomy.

Discussion

Plasmapheresis appears to be a safe and effective therapeutic option in patients with high-risk thyrotoxicosis, particularly in those with absolute contraindications to conventional treatments or severe cardiovascular comorbidities, facilitating stabilization and transition to definitive therapy.