SAT-396 Scenario Changing and Efficacy of Therapeutic Plasma Exchange in the Treatment of Thyrotoxicosis

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Abstract Disclosure: Z. Zhu: None. X. Gao: None. G. Bai: None. H. Wu: None. Y. Huang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background: Current guidelines primarily recommend TPE for thyroid storm, with limited recommendations for other indications of TPE in thyrotoxicosis. Due to the lack of randomized controlled trials, case reports and case series remain the main evidence guiding TPE in the treatment of thyrotoxicosis to date. Aim To summarize specific strategies and efficacy of TPE in different scenarios, providing guidance for TPE in thyrotoxicosis. Method A literature search of PubMed, Embase and Web of Science was conducted for case reports or case series published up to July 7, 2024 on TPE in thyrotoxicosis. The search identified 2152 records, of which 63 articles were accepted with a total of 103 patients. Results 103 patients from 63 studies and 2 from our center were involved, with a mean age of 45.8±16.6years, including 62 females. The main cause of thyrotoxicosis was Graves' disease (50.5%), followed by amiodarone-induced thyrotoxicosis (20.0%), iatrogenic thyrotoxicosis (7.6%), and others (12.4%). Indications for TPE were mainly thyroid storm (38%), contraindications to antithyroid drugs (ATD) (34.3%) and refractory to conventional therapies (24.8%), while rapid preoperative preparation was the least (2.9%). No significant difference was observed in the median TPE sessions for the above causes or indications (2.5 for thyroid storm and 3 for the others). Over time, the contraindications for ATD have become the leading indications for TPE (39.3%). Albumin (ALB) was the most common replacement fluid (47.6%), and compared to plasma, it was more significant in reducing FT3 (62.7% vs. 39.9%, P=0.0496) in total TPE course. For single TPE, ALB combined with plasma was more effective in reducing FT4 (29.14% vs. 13.38%, P=0.025) than using ALB alone, and plasma alone or combined with ALB were all superior to ALB alone in reducing AST (44.04%, 43.37% vs. -2.36%, P=0.003). A single TPE session can effectively reduce thyroid indices, primarily reducing TT4 (23.9%) and FT4 (19.6%), followed by TT3 (13.1%) and FT3 (15.7%); TRAb decreased by 48.7%. Additionally, liver enzymes were also reduced effectively, with reductions in AST (23.4%), ALT (28.3%), GGT (49.6%), and TBIL (23.3%). FT4 was a predictor of >3 TPE sessions (OR: 1.02, P=0.011) with a cutoff of 55.4 pmol/L (sensitivity: 65.38%, specificity: 70.45%, AUC: 0.71). 6 patients (5.71%) died, including 5 who took TPE due to thyroid storm. The incidence of adverse reactions was 12.4%, including bleeding or bleeding tendencies, allergic reactions and so on. Conclusion The primary indication for TPE has shifted to contraindications to ATD rather than thyroid storm, TPE effectively reduce thyroid indices and liver enzymes. TPE treatment of thyrotoxicosis has quite low mortality rate and incidence of adverse reactions, and deaths were mostly associated with TPE administered after thyroid storm, suggesting that earlier intervention with TPE may lead to better outcomes. Presentation: Saturday, July 12, 2025

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